Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1780342113 |
---|---|
Provider Name | Alexa Fraser Allen |
First Address | Albuquerque, NM 87120-3202 |
Second Address | Albuquerque, NM 87109-5283 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |