Annette Angela Baca, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Belen, NM

NPI 1003233172 · NPPES record last updated Mar 26, 2014

Key facts

NPI
1003233172
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
3073 (NM)
Practice address
520 N Main St
Belen, NM 87002-3720
Phone
(505) 966-1104
NPI assigned
Mar 26, 2014
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
3073NMMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 3073 NM Yes

Addresses

Primary practice location

520 N Main St
Belen, NM 87002-3720

Mailing address

520 N Main St
Belen, NM 87002-3720
Phone (505) 966-1104

Other providers in Belen, NM

All providers in Belen, NM · Occupational Therapy Assistant in New Mexico

Sources for this page

Verify at the official NPI Registry.