Provider Demographics
NPI:1639206105
Name:GASHYTEWA, CARRIE LYNETTE (MOTRL)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNETTE
Last Name:GASHYTEWA
Suffix:
Gender:F
Credentials:MOTRL
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 1023
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-1023
Mailing Address - Country:US
Mailing Address - Phone:505-782-6510
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH SANDY SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-4443
Practice Address - Fax:505-782-2600
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM83283536Medicaid