Individual
MS. MARICHU LAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
803 HACIENDA LANE, BLOOMFIELD, NM 87413
(505) 360-0799
Mailing address
318 N 7TH ST, BLOOMFIELD, NM 87413-5581
(505) 360-0799
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2456
NM
Other
Enumeration date
08/20/2010
Last updated
08/20/2010
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