Provider Demographics
NPI:1932831906
Name:PORTER, MACY ELIZABETH (MOTR/L)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:ELIZABETH
Last Name:PORTER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 TAYLOR RANCH RD NW STE C2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2962
Mailing Address - Country:US
Mailing Address - Phone:901-361-2009
Mailing Address - Fax:
Practice Address - Street 1:6911 TAYLOR RANCH RD NW STE C2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2962
Practice Address - Country:US
Practice Address - Phone:901-361-2009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4147225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist