Provider Demographics
NPI:1629458237
Name:MAHONEY-BARRACLOUGH, MAUREEN (MOTR-L, MS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MAHONEY-BARRACLOUGH
Suffix:
Gender:F
Credentials:MOTR-L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-1564
Mailing Address - Country:US
Mailing Address - Phone:505-412-2247
Mailing Address - Fax:
Practice Address - Street 1:116 ASPEN DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-1564
Practice Address - Country:US
Practice Address - Phone:505-412-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist