Individual
JONATHAN LERCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
3585
Contact information
Practice address
800 CORONADO RD, LOS LUNAS, NM 87031
(505) 865-9313
Mailing address
557 TRAMWAY BLVD NE, APT # 104, ALBUQUERQUE, NM 87123-2145
(412) 552-8109
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3585
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3585
—
NM
Enumeration date
10/19/2016
Last updated
10/19/2016
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