Provider Demographics
NPI:1073635876
Name:TAFUR, MARITZA MONTIEL (OT)
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:MONTIEL
Last Name:TAFUR
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 1:2605 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-2401
Mailing Address - Country:US
Mailing Address - Phone:505-341-0663
Mailing Address - Fax:
Practice Address - Street 1:713 CALIFORNIA ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3707
Practice Address - Country:US
Practice Address - Phone:505-265-2168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist