Individual provider Active NPI

Laurie Egbert, OT

  • Occupational Therapist
  • Albuquerque, NM
National Provider Identifier
1104012038
Registry record updated Sep 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
1278 Issued in NM
Practice address
1724 Camino del Valle SW
Adobe Acres Es
Albuquerque, NM 87105-6003
Phone
(505) 877-4799
NPI assigned
Sep 25, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 1278 NM Primary

Addresses

Primary practice location

1724 Camino del Valle SW
Adobe Acres Es
Albuquerque, NM 87105-6003

Mailing address

1724 Camino del Valle SW
Adobe Acres Es
Albuquerque, NM 87105-6003
Phone (505) 877-4799

Other identifiers 1

IdentifierTypeStateIssuer
T7287MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190678400000",
    "number": "1104012038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1724 CAMINO DEL VALLE SW",
            "address_2": "ADOBE ACRES ES",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056003",
            "telephone_number": "505-877-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1724 CAMINO DEL VALLE SW",
            "address_2": "ADOBE ACRES ES",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871056003",
            "telephone_number": "505-877-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGBERT",
        "first_name": "LAURIE",
        "credential": "OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NM",
            "license": "1278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T7287",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.