Individual
LISA JILL MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
(505) 255-5099
Mailing address
5200 COPPER AVE NE, ALBUQUERQUE, NM 87108-1473
(505) 255-5099
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1421
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B7913
—
NM
Enumeration date
09/27/2006
Last updated
07/08/2007
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