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General NPI Number Information
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NPI Number | 1295898633
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Entity Type | Individual
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Provider Name | LILA DENISE FAJARDO OTR
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 900 CENTRAL AVE
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City | BAYARD
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State | NM
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Zip | 88023
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Country | US
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Telephone | 575-537-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4211 N SILVER ST
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City | SILVER CITY
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State | NM
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Zip | 88061-7415
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Country | US
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Telephone | 575-534-9110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 3673
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License Number State | NM
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