Individual
JESSICA MIRANDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
11100 GIBSON BLVD SE UNIT D75, ALBUQUERQUE, NM 87123-3407
(505) 315-4389
Mailing address
11100 GIBSON BLVD SE UNIT D75, ALBUQUERQUE, NM 87123-3407
(505) 315-4389
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3219
NM
Other
Enumeration date
12/09/2016
Last updated
12/09/2016
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