Provider Demographics
NPI:1396895074
Name:HABELT, JOANNE (MOT OTR L)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:HABELT
Suffix:
Gender:F
Credentials:MOT OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CAMINO VALLE VERDE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-9309
Mailing Address - Country:US
Mailing Address - Phone:505-491-5276
Mailing Address - Fax:
Practice Address - Street 1:15 CAMINO VALLE VERDE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-9309
Practice Address - Country:US
Practice Address - Phone:505-491-5276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1645225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002711OtherNBCOT
NM1645OtherOT STATE LICENSE
NMG5794Medicaid
NM285549OtherLEVEL (3) K-12 OT LICENSE