Individual
AMY LANAE LARUSSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
119 LUNA ST SE, LOS LUNAS, NM 87031-6814
(205) 913-4524
Mailing address
4805 MARQUETTE AVE NE, APT 107, ALBUQUERQUE, NM 87108-1264
(205) 913-4524
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
12/07/2016
Last updated
12/07/2016
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