Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 3628 | NM |
NPI | 1104323609 |
---|---|
Provider Name | Kristen Grigsby |
First Address | Albuquerque, NM 87111-7811 |
Second Address | Albuquerque, NM 87109-4313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2018 |
Last Update Date | 11/04/2018 |