Individual
MS. MICHELE ELIZABETH DEROUEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSPTA
Contact information
Practice address
27 CALLE DE SUENOS, ALAMOGORDO, NM 88310-9501
(575) 491-1500
Mailing address
511 UTAH AVE, ALAMOGORDO, NM 88310-5932
(575) 491-1500
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
225200000X
Physical Therapy Assistant
A-0719
NM
Other
Enumeration date
11/16/2012
Last updated
04/14/2022
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