Provider Demographics
NPI:1265511356
Name:SNOWDEAL, CORAL LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:CORAL
Middle Name:LYNN
Last Name:SNOWDEAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7623 VIA BELLEZA SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-3377
Mailing Address - Country:US
Mailing Address - Phone:505-400-0624
Mailing Address - Fax:
Practice Address - Street 1:6519 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5812
Practice Address - Country:US
Practice Address - Phone:505-342-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics