Provider Demographics
NPI:1932449113
Name:MAKENA, BEBE (OTR/L)
Entity Type:Individual
Prefix:
First Name:BEBE
Middle Name:
Last Name:MAKENA
Suffix:
Gender:F
Credentials: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:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-0134
Mailing Address - Country:US
Mailing Address - Phone:575-779-5319
Mailing Address - Fax:
Practice Address - Street 1:1851 OLD US 66
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015
Practice Address - Country:US
Practice Address - Phone:505-281-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NM3933225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist