Individual
KRISTEN S. WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, OTR/L
Contact information
Practice address
608 BLEDSOE RD NW, LOS RANCHOS, NM 87107-6219
(505) 908-0717
Mailing address
1104 SALAMANCA ST NW, ALBUQUERQUE, NM 87107-5626
(505) 908-0717
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2414
NM
225XH1300X
Human Factors Occupational Therapist
2414
NM
225XN1300X
Neurorehabilitation Occupational Therapist
2414
NM
225XP0200X
Pediatric Occupational Therapist
2414
NM
Other
Enumeration date
12/17/2007
Last updated
04/12/2010
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