Amy Elizabeth Massey, OTR
Individual provider Active NPI Specialist · Bloomfield, NM
NPI 1639387632 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1639387632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 1496 (NM)
- Practice address
- 325 N Bergin LN
Bloomfield, NM 87413-6729 - Phone
- (505) 632-2121
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1496 | NM | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1496 | NM | Yes |
Addresses
Primary practice location
325 N Bergin LN
Bloomfield, NM 87413-6729
Mailing address
3709 Buckingham St
Farmington, NM 87402-4737
Phone (505) 947-4652
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00073806 | Medicaid | NM |
Other providers in Bloomfield, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.