Individual
TEAGAN BREANN HOLMES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5901 OURAY RD NW, ALBUQUERQUE, NM 87120-1381
(769) 231-2771
Mailing address
100 ADAMS AVE, MAGEE, MS 39111-3027
(769) 231-2771
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA4610
NM
Other
Enumeration date
01/19/2022
Last updated
03/07/2022
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