MEDICARE: JUDY BARKER

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	225XE0001X	Environmental Modification Occupational Therapist	OT3953	NM

General Provider Information

NPI Number	:	1912514621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY BARKER

Provider Business Mailing Address
First Line	:	5144 MESA DEL OSO RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3708
Country	:	US
Telephone Number	:	505-307-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	5144 MESA DEL OSO RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3708
Country	:	US
Telephone Number	:	505-307-0082
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	09/26/2020

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Directions to “ JUDY BARKER ” Practice Location

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