Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 653 | NM |
NPI | 1003036443 |
---|---|
Provider Name | Laura E Salem |
First Address | Moriarty, NM 87035-2000 |
Second Address | Moriarty, NM 87035-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Z2875 | (05) | NM |