Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 450 | NM |
NPI | 1003960618 |
---|---|
Provider Name | Sidney T Alley |
First Address | Albuquerque, NM 87102-3840 |
Second Address | Albuquerque, NM 87102-3840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
68903 | (05) | NM |