Active NPI
Susan Gillen
- Occupational Therapy Assistant
- Albuquerque, NM
National Provider Identifier
1124416953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- 1587
- Practice address
- 3600 Eubank Blvd NE
Unit 9B
Albuquerque, NM 87111-4846 - Phone
- (505) 620-3976
- Fax
- (505) 923-4850
- NPI assigned
- Jan 1, 2015
- 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 Therapy Assistant | 224Z00000X | 1587 | NM | Primary |
Addresses
Primary practice location
3600 Eubank Blvd NE
Unit 9B
Albuquerque, NM 87111-4846
Mailing address
3600 Eubank Blvd NE
Unit 9B
Albuquerque, NM 87111-4846
Phone (505) 620-3976
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 |
|---|---|---|---|
| 1587 | NM | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1420070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420070400000",
"number": "1124416953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 EUBANK BLVD NE",
"address_2": "UNIT 9B",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871114846",
"telephone_number": "505-620-3976",
"fax_number": "505-923-4850"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 EUBANK BLVD NE",
"address_2": "UNIT 9B",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871114846",
"telephone_number": "505-620-3976",
"fax_number": "505-923-4850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLEN",
"first_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-01",
"last_updated": "2015-01-01",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "NM",
"license": "1587",
"primary": true
}
],
"identifiers": [],
"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 Jan 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.