MEDICARE: TAL THERAPIES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	225700000X	Massage Therapist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1679118707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAL THERAPIES LLC

Provider Business Mailing Address
First Line	:	238 AMBROSIO ST APT 1
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-2868
Country	:	US
Telephone Number	:	575-770-5836
Fax Number	:	505-982-0732

Provider Business Practice Location Address
First Line	:	150 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-2445
Country	:	US
Telephone Number	:	575-770-5836
Fax Number	:	505-982-0732

Authorized Official
Title or Position	:	OWNER/ OCCUPATIONAL THERAPIST
Name	:	MS. TERESA ANN LIFVERGREN
Credential	:	OTL/R
Telephone Number	:	575-770-5360

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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Directions to “TAL THERAPIES LLC ” Practice Location

Language	Start Address	Practice Location

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