Individual
MR. KEITH KELLY STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1268 E 32ND ST, SILVER CITY, NM 88061-7229
(575) 534-1919
(575) 534-0135
Mailing address
1268 E 32ND ST, SILVER CITY, NM 88061-7229
(575) 534-1919
(575) 534-0135
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2496
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2496
STATE LICENSE
NM
Enumeration date
01/13/2009
Last updated
01/13/2009
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