Organization
KIDSBRIDGE OCCUPATIONAL THERAPY
Active
Parent organization
KIDSBRIDGE OCCUPATIONAL THERAPY
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIDSBRIDGE OCCUPATIONAL THERAPY
Authorized official
MRS. KRISTEN S WIESE MA OTR/L (OWNER/OPERATOR)
(505) 908-0717
Entity
Organization
Contact information
Practice address
1104 SALAMANCA ST NW, LOS RANCHOS, NM 87107-5626
(505) 908-0717
(505) 344-5553
Mailing address
1104 SALAMANCA ST NW, LOS RANCHOS, NM 87107-5626
(505) 908-0717
(505) 344-5553
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2414
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1841473527
NPI FOR INDIVIDUAL
NM
Enumeration date
12/22/2012
Last updated
12/22/2012
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