Provider Demographics
NPI:1003452012
Name:BLUE STAR THERAPY, LLC
Entity Type:Organization
Organization Name:BLUE STAR THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OTR
Authorized Official - Prefix:
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:575-317-7643
Mailing Address - Street 1:611 W. MAHONE DR.
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210
Mailing Address - Country:US
Mailing Address - Phone:575-317-7643
Mailing Address - Fax:
Practice Address - Street 1:611 W. MAHONE DR.
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-317-7643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty