Provider Demographics
NPI:1245351840
Name:MORALES, CAESAR (OT)
Entity type:Individual
Prefix:
First Name:CAESAR
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 STATE HIGHWAY 14 N
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-9308
Mailing Address - Country:US
Mailing Address - Phone:505-281-3931
Mailing Address - Fax:
Practice Address - Street 1:12555 STATE HIGHWAY 14 N
Practice Address - Street 2:
Practice Address - City:SANDIA PARK
Practice Address - State:NM
Practice Address - Zip Code:87047-9308
Practice Address - Country:US
Practice Address - Phone:505-281-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ9545Medicaid