Provider Demographics
NPI:1740576446
Name:JUDY DEINEMA OCCUPATIONAL THERAPY SERVICES
Entity type:Organization
Organization Name:JUDY DEINEMA OCCUPATIONAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEINEMA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:505-688-7363
Mailing Address - Street 1:28 MANANA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9414
Mailing Address - Country:US
Mailing Address - Phone:505-688-7363
Mailing Address - Fax:505-286-6152
Practice Address - Street 1:1100 ALVARADO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6558
Practice Address - Country:US
Practice Address - Phone:505-688-7363
Practice Address - Fax:505-286-6152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM901225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty