Individual
BREANNE KONICHEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 N RICHARDSON AVE, ROSWELL, NM 88201-4920
(575) 622-6260
Mailing address
3740 E CROSSROADS, ROSWELL, NM 88203-9011
(575) 910-0268
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2025-0198
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA4415
NM OTA LICENSE
NM
Enumeration date
01/27/2021
Last updated
11/19/2025
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