Provider Demographics
NPI:1043808330
Name:MORIEL, MARISOL (OT)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:MORIEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-1522
Mailing Address - Country:US
Mailing Address - Phone:575-420-0723
Mailing Address - Fax:
Practice Address - Street 1:610 W BENDER BLVD STE 1300
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2241
Practice Address - Country:US
Practice Address - Phone:575-433-2002
Practice Address - Fax:888-729-4956
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOTA4384224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant