Healthcare Provider Details

I. General information

NPI: 1669953105
Provider Name (Legal Business Name): PATRICIA A ZIEHL COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 LUNA AVE.
LOS LUNAS NM
87031
US

IV. Provider business mailing address

119 LUNA AVE.
LOS LUNAS NM
87031
US

V. Phone/Fax

Practice location:
  • Phone: 505-866-6398
  • Fax:
Mailing address:
  • Phone: 505-866-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3544
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: