Individual
MS. CHAMA ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Contact information
Practice address
832 W HWY 60, SOCORRO, NM 87801
(505) 838-1100
(505) 838-0394
Mailing address
1002 WALKWAY PLACE, SOCORRO, NM 87801
(505) 418-9014
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1969
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93657366
—
NM
Enumeration date
08/30/2006
Last updated
07/08/2007
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