Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 3126 | NM |
NPI | 1023430998 |
---|---|
Provider Name | Loretta Contreras |
First Address | Roswell, NM 88201-4636 |
Second Address | Roswell, NM 88201-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2014 |
Last Update Date | 13/01/2014 |