MEDICARE: RAJENA CLOUSE

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	225XP0200X	Pediatric Occupational Therapist	2416	NM

General Provider Information

NPI Number	:	1811170970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJENA CLOUSE

Provider Business Mailing 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	:	505-268-8021

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	:	505-268-8021

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

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	12/12/2007

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Directions to “ RAJENA CLOUSE ” Practice Location

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