MEDICARE: MRS. PATRICIA A WHITESEL OT

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
1	225X00000X	Occupational Therapist	1140	NM

General Provider Information

NPI Number	:	1609967801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA A WHITESEL OT

Provider Business Mailing Address
First Line	:	9101 DEMPSEY DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-6334
Country	:	US
Telephone Number	:	505-463-6452
Fax Number	:	505-256-6414

Provider Business Practice Location Address
First Line	:	1501 SAN PEDRO DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-5153
Country	:	US
Telephone Number	:	505-265-1711
Fax Number	:	505-256-6414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/06/2023

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