Chama Etheridge, OTR L
Individual provider Active NPI Occupational Therapist · Socorro, NM
NPI 1972613693 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972613693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 1969 (NM)
- Practice address
- 832 W Hwy 60
Socorro, NM 87801 - Phone
- (505) 838-1100
- Fax
- (505) 838-0394
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Body Wise Therapy Services LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 1969 | NM | Yes |
Addresses
Primary practice location
832 W Hwy 60
Socorro, NM 87801
Mailing address
1002 Walkway Place
Socorro, NM 87801
Phone (505) 418-9014
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93657366 | Medicaid | NM |
Other providers in Socorro, NM
- Melissa D Edmondson
- Eei, LLC
- Elite Dental LLC
- Enchantment Home Health MGMT
- Naomi Mae Erives
- Eye Associates of New Mexico, LTD.
- Kary M Felt
- Martin Alan Fenner
- Debra Sheryl Fitzgerald
- Jason Lee Frame Jr.
All providers in Socorro, 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.