Individual
KRISTY JO ELLA EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
810 W MAPLE ST, FARMINGTON, NM 87401-5631
(505) 609-6013
Mailing address
2111 SCHOFIELD LN, FARMINGTON, NM 87401-2522
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3402
NM
Other
Enumeration date
12/09/2017
Last updated
12/09/2017
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