Individual
DWINELL L HEVERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS OT
Contact information
Practice address
901 DOUGLAS AVE, LAS VEGAS, NM 87701-3928
(505) 454-5700
(505) 454-5702
Mailing address
1 WILD FLOWER RD, LAS VEGAS, NM 87701-9667
(505) 426-1753
(505) 454-5702
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1457
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
225X00000X
—
NM
Enumeration date
03/14/2007
Last updated
07/09/2007
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