Individual
HEATHER LEIGH PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
5006 COPPER AVE NE, ALBUQUERQUE, NM 87108-1301
(505) 268-7988
(505) 268-8021
Mailing address
904 HOLLYWOOD BLVD, CORRALES, NM 87048-8478
(505) 280-6534
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
2895
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10171568
—
NM
01
—
326556
MEDICARE
NM
Enumeration date
02/27/2012
Last updated
02/27/2012
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