Provider Demographics
NPI:1447815618
Name:NELSON, DENISE KRISTEN (COTA/L)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:KRISTEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 TERRA DE SOL DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8864
Mailing Address - Country:US
Mailing Address - Phone:505-514-5097
Mailing Address - Fax:
Practice Address - Street 1:8820 HORIZON BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1689
Practice Address - Country:US
Practice Address - Phone:505-998-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOTA3373224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant