Provider Demographics
NPI:1669913752
Name:OBERLOH, AUDRA MARIAH
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:MARIAH
Last Name:OBERLOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1522
Mailing Address - Country:US
Mailing Address - Phone:206-265-2695
Mailing Address - Fax:
Practice Address - Street 1:424 ALAMO DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1522
Practice Address - Country:US
Practice Address - Phone:206-265-2695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician