MEDICARE: CAROL L MAUPIN-MACIAS OTR

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	107317	TX
2	225X00000X	Occupational Therapist	2123	NM

General Provider Information

NPI Number	:	1912036278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL L MAUPIN-MACIAS OTR

Provider Business Mailing Address
First Line	:	1300 COUNTRY CLUB RD
Second Line	:	SUITE C
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9449
Country	:	US
Telephone Number	:	575-589-0303
Fax Number	:	575-589-4080

Provider Business Practice Location Address
First Line	:	1300 COUNTRY CLUB RD
Second Line	:	SUITE C
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9449
Country	:	US
Telephone Number	:	575-589-0303
Fax Number	:	575-589-4080

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	01/28/2013

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