Provider Demographics
NPI:1952449498
Name:DEPPA THERAPY SERVICES P.C.
Entity Type:Organization
Organization Name:DEPPA THERAPY SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPPA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:505-265-2168
Mailing Address - Street 1:713 CALIFORNIA ST SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-3707
Mailing Address - Country:US
Mailing Address - Phone:505-265-2168
Mailing Address - Fax:505-265-7156
Practice Address - Street 1:713 CALIFORNIA ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-3707
Practice Address - Country:US
Practice Address - Phone:505-265-2168
Practice Address - Fax:505-265-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM249225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD1468Medicaid
NM32759002Medicaid