Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2399 | NM |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 2399 | NM |
N | 225XP0200X | Occupational Therapist - Pediatrics | 2399 | NM |
NPI | 1841446598 |
---|---|
Provider Name | Mr. Harrison Eraste Guillory |
First Address | Albuquerque, NM 87111-1549 |
Second Address | Albuquerque, NM 87111-1549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 13/08/2008 |