Provider Demographics
NPI:1891207825
Name:SEIGEL, MIRIAM DOLORES (COTA/L)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:DOLORES
Last Name:SEIGEL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:DOLORES
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:4210 SABANA GRANDE AVE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1152
Mailing Address - Country:US
Mailing Address - Phone:505-892-6603
Mailing Address - Fax:
Practice Address - Street 1:4210 SABANA GRANDE AVE SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1152
Practice Address - Country:US
Practice Address - Phone:505-892-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM22682081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine