Individual
LAURA J. VISANKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
4151 CAMINO COYOTE, SUITE A, LAS CRUCES, NM 88011-5111
(575) 522-0484
(575) 522-0483
Mailing address
4151 CAMINO COYOTE, SUITE A, LAS CRUCES, NM 88011-7096
(575) 522-0484
(575) 522-0483
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
731
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79400507
—
NM
01
—
NM00Q038
BLUE CROSS BLUE SHIELD
NM
01
—
PROVP16915
MOLINA HEALTH PLAN
NM
Enumeration date
07/30/2006
Last updated
03/08/2017
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