Provider Demographics
NPI:1245770239
Name:SEARS, ANJULI ROSE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ANJULI
Middle Name:ROSE
Last Name:SEARS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:ANJULI
Other - Middle Name:ROSE
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2616 MCEARL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3007
Mailing Address - Country:US
Mailing Address - Phone:505-506-3329
Mailing Address - Fax:
Practice Address - Street 1:2616 MCEARL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-3007
Practice Address - Country:US
Practice Address - Phone:505-506-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3654225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10171568Medicaid
NM326556OtherMEDICARE