Provider Demographics
NPI:1326766163
Name:APODACA, GEORGIANA (COTA)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:APODACA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S GOLD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-3755
Mailing Address - Country:US
Mailing Address - Phone:575-283-0200
Mailing Address - Fax:575-283-0238
Practice Address - Street 1:122 S GOLD AVE STE A
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3755
Practice Address - Country:US
Practice Address - Phone:575-283-0200
Practice Address - Fax:575-283-0238
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3692224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant