Provider Demographics
NPI:1497919153
Name:PARKER, ROXANNE MICHELLE (OTL/R)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MICHELLE
Last Name:PARKER
Suffix:
Gender:F
Credentials:OTL/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LONGVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9335
Mailing Address - Country:US
Mailing Address - Phone:505-362-3708
Mailing Address - Fax:
Practice Address - Street 1:36 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9335
Practice Address - Country:US
Practice Address - Phone:505-362-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30887551Medicaid