Healthcare Provider Details

I. General information

NPI: 1205955143
Provider Name (Legal Business Name): MARIAN M GIRMUS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAN MILLER OTRL

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 03/08/2023
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD STE 6
SANTA FE NM
87508-9208
US

IV. Provider business mailing address

3 CALIENTE RD STE 6
SANTA FE NM
87508-9208
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-4424
  • Fax:
Mailing address:
  • Phone: 505-436-1163
  • Fax: 505-636-5172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: