Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3378 | NM |
N | 224Z00000X | Occupational Therapy Assistant | 3445 | CA |
NPI | 1013377688 |
---|---|
Provider Name | Gina Maciel |
First Address | Albuquerque, NM 87114-5201 |
Second Address | Albuquerque, NM 87114-5201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 25/02/2016 |