Individual
PROF. DEMITRI MARIE BLIESNER I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7540 N 19TH AVE STE 200, PHOENIX, AZ 85021-7967
(188) 887-3422
Mailing address
31 ROAD 5198, BLOOMFIELD, NM 87413-9713
(505) 402-8419
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3816
NM
Other
Enumeration date
11/14/2017
Last updated
11/14/2017
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