Individual
MS. AUDREY SUSAN PETZOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
32 CUCHILLA DE LUPE RD, PLACITAS, NM 87043-8716
(505) 867-5203
Mailing address
32 CUCHILLA DE LUPE RD, PLACITAS, NM 87043-8716
(505) 867-5203
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1181
NM
225XM0800X
Mental Health Occupational Therapist
1181
NM
225XP0200X
Pediatric Occupational Therapist
Primary
1181
NM
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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