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Individual

MARICELA BUSTILLOS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
18 W WASHINGTON AVE, LOVINGTON, NM 88260-4023
(575) 739-2705
Mailing address
513 W HARRISON AVE, LOVINGTON, NM 88260-2709
(575) 942-1661

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4682
NM

Other

Enumeration date
08/09/2022
Last updated
08/09/2022
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