Individual
MR. NATHAN PACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, OTRL
Contact information
Practice address
NORTH HIGHWAY 63, PECOS, NM 87552-0368
(505) 757-4606
Mailing address
509 PAIGE LOOP, LOS ALAMOS, NM 87544-3622
(505) 672-9370
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2311
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95307257
—
NM
Enumeration date
02/08/2007
Last updated
07/08/2007
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