Active NPI
Miranda Walenta
- Occupational Therapist
- Albuquerque, NM
National Provider Identifier
1104955764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2183
- Practice address
- 4216 Balloon Park Rd NE
Albuquerque, NM 87109-5801 - Phone
- (505) 344-5470
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2183 | NM | Primary |
Addresses
Primary practice location
4216 Balloon Park Rd NE
Albuquerque, NM 87109-5801
Mailing address
2385 Camino Pintores
Santa Fe, NM 87505-5290
Phone (505) 730-9514
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62154789 | Medicaid | NM |
Other names 1
- Miranda Heeter
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2183 | NM | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cooperative Educational Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Local Education Agency (LEA)
- Albuquerque, NM
- NPI 1720132707
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104955764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2385 CAMINO PINTORES",
"city": "SANTA FE",
"state": "NM",
"postal_code": "875055290",
"telephone_number": "505-730-9514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4216 BALLOON PARK RD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871095801",
"telephone_number": "505-344-5470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALENTA",
"first_name": "MIRANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "2183",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "62154789",
"state": "NM"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MIRANDA",
"last_name": "HEETER",
"code": "1",
"type": "Former Name"
}
]
}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 Jul 8, 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.