Individual
OMAR VILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
224 E NIZHONI BLVD, GALLUP, NM 87301-5744
(505) 863-9551
Mailing address
224 E NIZHONI BLVD, GALLUP, NM 87301-5744
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA4506
NM
Other
Enumeration date
12/28/2021
Last updated
12/28/2021
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