Provider Demographics
NPI:1841375243
Name:SPANGLER, THOR RAYMOND (OTR/L)
Entity type:Individual
Prefix:MR
First Name:THOR
Middle Name:RAYMOND
Last Name:SPANGLER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5112 PASTURA PL NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3849
Mailing Address - Country:US
Mailing Address - Phone:505-345-0805
Mailing Address - Fax:505-345-2534
Practice Address - Street 1:MITCHELL ELEMENTARY 10121 COMANCHE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-299-1937
Practice Address - Fax:505-296-0012
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1497225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73841Medicaid