Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1509 | NM |
NPI | 1912305129 |
---|---|
Provider Name | Heather Carrington |
First Address | Albuquerque, NM 87110-7513 |
Second Address | Albuquerque, NM 87110-7513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2014 |
Last Update Date | 22/12/2014 |