Individual
LESLIE A CRIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BIS
Contact information
Practice address
323 S 5TH ST, CLAYTON, NM 88415-2641
(575) 207-8646
Mailing address
323 S 5TH ST, CLAYTON, NM 88415-2641
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA2407
NM
Other
Enumeration date
12/09/2022
Last updated
12/09/2022
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