Individual
SHANNON ORTEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
(505) 255-5099
(505) 255-4206
Mailing address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1424
NM
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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