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NPI Code Detail

MEDICARE: MR. JASON JOHN SILVA OTR/L

MEDICARE: MR. JASON JOHN SILVA OTR/L
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 TherapistOT4603NM

General Provider Information

NPI Number : 1881966364
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JASON JOHN SILVA OTR/L
Provider Business Mailing Address
First Line : PO BOX 603
Second Line :
City : BAYARD
State : NM
Zip : 88023-0603
Country : US
Telephone Number : 808-756-2712
Fax Number :
Provider Business Practice Location Address
First Line : 5901 OURAY RD NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87120-1381
Country : US
Telephone Number : 505-836-0023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2012
Last Update Date : 01/28/2022

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