Provider Demographics
NPI:1912036278
Name:MAUPIN-MACIAS, CAROL L (OTR)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:MAUPIN-MACIAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9449
Mailing Address - Country:US
Mailing Address - Phone:575-589-0303
Mailing Address - Fax:575-589-4080
Practice Address - Street 1:1300 COUNTRY CLUB RD
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9449
Practice Address - Country:US
Practice Address - Phone:575-589-0303
Practice Address - Fax:575-589-4080
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107317225X00000X
NM2123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676555Medicare Oscar/Certification
TX676626Medicare Oscar/Certification
TX676559Medicare Oscar/Certification
TX676554Medicare Oscar/Certification
TX676564Medicare Oscar/Certification
NM349732307Medicare PIN