Individual
SUSAN L WINDECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
STATE ROAD 531, TIERRA AMARILLA, NM 87575-9701
(505) 588-7285
Mailing address
PO BOX 672, TIERRA AMARILLA, NM 87575-0672
(505) 756-9159
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
112
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53116
—
NM
Enumeration date
12/18/2006
Last updated
07/08/2007
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