Healthcare Provider Details

I. General information

NPI: 1003452012
Provider Name (Legal Business Name): BLUE STAR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W. MAHONE DR.
ARTESIA NM
88210
US

IV. Provider business mailing address

611 W. MAHONE DR.
ARTESIA NM
88210
US

V. Phone/Fax

Practice location:
  • Phone: 575-317-7643
  • Fax:
Mailing address:
  • Phone: 575-317-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELSA A PAEZ
Title or Position: OWNER/OTR
Credential: MOTR/L
Phone: 575-317-7643