Facts
- Status
- A
- Credential
- COTA/L
- Type
- Individual
- Enumeration date
- 2014-03-26
- Last updated
- 2014-03-26
Specialties
Licenses
- License NM
- 3073
Location
- Practice location
- 520 N MAIN ST
- City
- BELEN NM
- Postal code
- 870023720
- Phone
- 505-966-1104
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.