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NPI Code Detail

MEDICARE: MIKAELA PIERCE OT

MEDICARE: MIKAELA PIERCE 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
1225X00000XOccupational Therapist1653NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629123013
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAELA PIERCE OT
Provider Business Mailing Address
First Line : 5100 MARNA LYNN AVE NW
Second Line : PETROGLYPH ES
City : ALBUQUERQUE
State : NM
Zip : 87114-5701
Country : US
Telephone Number : 505-898-0923
Fax Number :
Provider Business Practice Location Address
First Line : 5100 MARNA LYNN AVE NW
Second Line : PETROGLYPH ES
City : ALBUQUERQUE
State : NM
Zip : 87114-5701
Country : US
Telephone Number : 505-898-0923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/09/2007

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Directions to “ MIKAELA PIERCE OT” Practice Location

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