Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 784 | NM |
NPI | 1306205901 |
---|---|
Provider Name | Michael Mccague III |
First Address | Las Cruces, NM 88007-5572 |
Second Address | Las Cruces, NM 88011-0853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2016 |
Last Update Date | 11/02/2016 |