Individual
MR. BRYAN CODY DETERMAN SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1400 N SILVER ST, TRUTH OR CONSEQUENCES, NM 87901-1957
(575) 894-7855
Mailing address
600 W ALAMEDA ST, ROSWELL, NM 88203-4402
(575) 623-0882
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2404
NM
Other
Enumeration date
06/13/2008
Last updated
06/13/2008
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