Provider Demographics
NPI:1730473877
Name:SEWELL, BETH A (MHS, OT/L)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:A
Last Name:SEWELL
Suffix:
Gender:F
Credentials:MHS, OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 SILVERWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2196
Mailing Address - Country:US
Mailing Address - Phone:972-998-4079
Mailing Address - Fax:
Practice Address - Street 1:9108 SILVERWOOD DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2196
Practice Address - Country:US
Practice Address - Phone:972-998-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2749225X00000X
TX113108225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist