Basic Information
| Provider Information | |||||||||
| NPI: | 1881841906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SYLVESTER | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6325 MILNE RD NW | ||||||||
| Address2: | CHAPARRAL ES | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871201691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058313301 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6325 MILNE RD NW | ||||||||
| Address2: | CHAPARRAL ES | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871201691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058313301 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 08/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1352 | NM | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | NONE ASSIGNED | 05 | NM | MEDICAID |