Provider Demographics
NPI:1215486840
Name:HOUSER, TALIA (MOTR/L)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:HOUSER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:
Other - Last Name:BARTOLOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8205 PORTALES ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4955
Mailing Address - Country:US
Mailing Address - Phone:505-263-0583
Mailing Address - Fax:
Practice Address - Street 1:898 HWY 304
Practice Address - Street 2:
Practice Address - City:VEGUITA
Practice Address - State:NM
Practice Address - Zip Code:87062
Practice Address - Country:US
Practice Address - Phone:505-966-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3578225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist