Individual
STACEY MARIE BENTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
19 ROAD 3390, AZTEC, NM 87410-9573
(505) 860-3766
Mailing address
PO BOX 418, AZTEC, NM 87410-0418
(505) 860-3766
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2092
NM
Other
Enumeration date
10/12/2006
Last updated
07/08/2007
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