Individual
JENNIFER SUE FAUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
463 S ROOSEVELT ROAD O, PORTALES, NM 88130-9676
(505) 760-6691
Mailing address
463 S ROOSEVELT ROAD O, PORTALES, NM 88130-9676
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1581
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1581
COTA
NM
Enumeration date
03/09/2007
Last updated
07/08/2007
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