Provider Demographics
NPI:1235262916
Name:MIKSCH, ABBEY (OT)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:MIKSCH
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 1:2300 ARENAL RD SW
Mailing Address - Street 2:RIO GRANDE HS
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-4160
Mailing Address - Country:US
Mailing Address - Phone:505-873-0220
Mailing Address - Fax:
Practice Address - Street 1:2300 ARENAL RD SW
Practice Address - Street 2:RIO GRANDE HS
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4160
Practice Address - Country:US
Practice Address - Phone:505-873-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2193225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM23373059Medicaid