Provider Demographics
NPI:1497898357
Name:MOCHAN, MARY (OT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MOCHAN
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:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-0642
Mailing Address - Country:US
Mailing Address - Phone:505-838-0800
Mailing Address - Fax:505-838-3999
Practice Address - Street 1:1115 N. CALIFORNIA ST.
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-0642
Practice Address - Country:US
Practice Address - Phone:505-838-0800
Practice Address - Fax:505-838-3999
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00P3051Medicaid
NM84521228Medicaid
NMD4005Medicaid
NML5902Medicaid