Provider Demographics
NPI:1942270087
Name:MOEDL, DENISE I (OTRL)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:I
Last Name:MOEDL
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
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Mailing Address - Street 1:12068 CRIMSON GLORY RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-822-8998
Mailing Address - Fax:
Practice Address - Street 1:5006 COPPER NE
Practice Address - Street 2:EXPLORABILITIES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-268-7988
Practice Address - Fax:505-268-8021
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM1145225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics