Individual
GWENDOLYN J DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1506 AVENIDA DE LAS AMERICA, SANTA FE, NM 87507-5079
(413) 588-4251
Mailing address
1506 AVENIDA DE LAS AMERICA, SANTA FE, NM 87507-5079
(413) 588-4251
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
01/02/2018
Last updated
01/02/2018
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