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NPI Code Detail

MEDICARE: AUDREY LYNN PADILLA COOPER

MEDICARE:   AUDREY LYNN PADILLA COOPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2281NM

General Provider Information

NPI Number : 1235328915
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY LYNN PADILLA COOPER
Provider Business Mailing Address
First Line : 10438 CUEVA DEL OSO NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-3765
Country : US
Telephone Number : 505-934-5096
Fax Number :
Provider Business Practice Location Address
First Line : 5006 COPPER AVE NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87108-1301
Country : US
Telephone Number : 505-268-7988
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2007
Last Update Date : 12/01/2023

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Directions to “ AUDREY LYNN PADILLA COOPER ” Practice Location

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