Provider Demographics
NPI:1952431322
Name:NORE, DARLA O (OTRL)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:O
Last Name:NORE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:DARLA
Other - Middle Name:J
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:4612 JUPITER ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3945
Mailing Address - Country:US
Mailing Address - Phone:505-342-0245
Mailing Address - Fax:
Practice Address - Street 1:4612 JUPITER ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3945
Practice Address - Country:US
Practice Address - Phone:505-342-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1129225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ6974Medicaid