Active NPI
Michelle Randall, MOTR-L
- Occupational Therapist
- Bosque Farms, NM
National Provider Identifier
1407489040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 980 Bosque Farms Blvd
Bosque Farms, NM 87068-9652 - Phone
- (505) 554-0052
- NPI assigned
- Feb 21, 2020
- Last updated
- Nov 14, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | Primary | ||
| Pediatric Occupational Therapist | 225XP0200X |
Addresses
Primary practice location
980 Bosque Farms Blvd
Bosque Farms, NM 87068-9652
Mailing address
2325 Stevens Dr NE
Albuquerque, NM 87112-1449
Phone (505) 321-8217
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396354981 | Medicaid | NM |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bosque Therapy Center, LLC | Pediatrics | Current | Accepting new patients |
| Explorabilities Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Albuquerque, NM
- NPI 1346210473
Occupational Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668384000000",
"number": "1407489040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 STEVENS DR NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871121449",
"telephone_number": "505-321-8217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "980 BOSQUE FARMS BLVD",
"city": "BOSQUE FARMS",
"state": "NM",
"postal_code": "870689652",
"telephone_number": "505-554-0052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDALL",
"first_name": "MICHELLE",
"credential": "MOTR-L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-02-21",
"last_updated": "2022-11-14",
"certification_date": "2022-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "225XP0200X",
"taxonomy_group": "",
"desc": "Occupational Therapist, Pediatrics",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1396354981",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bosque Farms, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.