Provider Demographics
NPI:1043357569
Name:VAN DAME, VICTORIA (OTR/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VAN DAME
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 CENTRAL AVE NW
Mailing Address - Street 2:P O BOX 2779
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3007
Mailing Address - Country:US
Mailing Address - Phone:505-249-2231
Mailing Address - Fax:
Practice Address - Street 1:709 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3007
Practice Address - Country:US
Practice Address - Phone:505-249-2231
Practice Address - Fax:505-212-0605
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1781225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist