Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2414 | NM |
N | 2251H1300X | Human Factors | 2414 | NM |
N | 225XH1300X | Human Factors | 2414 | NM |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2414 | NM |
N | 225XP0200X | Occupational Therapist - Pediatrics | 2414 | NM |
NPI | 1841473527 |
---|---|
Provider Name | Kristen S. Wiese |
First Address | Albuquerque, NM 87107-5626 |
Second Address | Los Ranchos, NM 87107-6219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 12/04/2010 |