Individual
BONNIE NUTTALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
4040 SAN ISIDRO ST NW, GRIEGOS ES, ALBUQUERQUE, NM 87107-2828
(505) 345-3661
Mailing address
4040 SAN ISIDRO ST NW, GRIEGOS ES, ALBUQUERQUE, NM 87107-2828
(505) 345-3661
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1786
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18577750
—
NM
Enumeration date
03/14/2007
Last updated
07/09/2007
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