Nathan Pack, MA, OTRL
Individual provider Active NPI Occupational Therapist · Pecos, NM
NPI 1710028485 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710028485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 2311 (NM)
- Practice address
- North Highway 63
Pecos, NM 87552-0368 - Phone
- (505) 757-4606
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2311 | NM | MD | Occupational Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2311 | NM | Yes |
Addresses
Primary practice location
North Highway 63
Pecos, NM 87552-0368
Mailing address
509 Paige Loop
Los Alamos, NM 87544-3622
Phone (505) 672-9370
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 95307257 | Medicaid | NM |
Other providers in Pecos, NM
- Lilia Lopez de Varela
- Susan Upton Lovro
- Brigette K Lucero
- Virginia McNally
- Pamela Ortiz
- Pecos Independent School District
- Pecos Valley Ambulance Service
- Pecos Valley Ambulance Service
- Pecos Valley Medical Center, Inc
- Pecos Valley Medical Center, Inc
All providers in Pecos, NM · Occupational Therapist in New Mexico
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.