Active NPI
Glenda Marie Moore, O. T.
- Occupational Therapist
- Corrales, NM
National Provider Identifier
1801938436
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1107
- Practice address
- 371 Sereno Rd
Corrales, NM 87048-8625 - Phone
- (505) 352-7391
- Fax
- (505) 352-7391
- NPI assigned
- Feb 12, 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 | 1107 | NM | Primary |
Addresses
Primary practice location
371 Sereno Rd
Corrales, NM 87048-8625
Mailing address
371 Sereno Rd
Corrales, NM 87048-8625
Phone (505) 352-7391
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A2161 | Medicaid | NM | |
| Q6968 | 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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1801938436",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "371 SERENO RD",
"city": "CORRALES",
"state": "NM",
"postal_code": "870488625",
"telephone_number": "505-352-7391",
"fax_number": "505-352-7391"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "371 SERENO RD",
"city": "CORRALES",
"state": "NM",
"postal_code": "870488625",
"telephone_number": "505-352-7391",
"fax_number": "505-352-7391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "GLENDA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "O. T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NM",
"license": "1107",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A2161",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Q6968",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Corrales, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.