Individual
KLANESE KRYSTAL HATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
180 N. DATE STREET, T OR C, NM 87901
(575) 894-8372
Mailing address
PO BOX 86, CLIFF, NM 88028
(575) 535-2499
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3565
NM
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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