Provider Demographics
NPI:1851763080
Name:POORBAUGH, TRISHA (COTA/L)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:POORBAUGH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:K
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 ALCAZAR ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7109
Mailing Address - Country:US
Mailing Address - Phone:319-400-1126
Mailing Address - Fax:
Practice Address - Street 1:1313 ALCAZAR ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7109
Practice Address - Country:US
Practice Address - Phone:319-400-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6316224Z00000X
NM2949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist