Provider Demographics
NPI:1750970893
Name:PAINTED SKY THERAPY LLC
Entity type:Organization
Organization Name:PAINTED SKY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKENA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:575-779-5319
Mailing Address - Street 1:1103 PASEO DEL PUEBLO NORTE # 114
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-7539
Mailing Address - Country:US
Mailing Address - Phone:575-779-5319
Mailing Address - Fax:
Practice Address - Street 1:428 THEODORA ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6396
Practice Address - Country:US
Practice Address - Phone:575-779-5319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine