Provider Demographics
NPI:1376702209
Name:RICHARDS, GARY M (COTA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:M
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 BOTULPH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1107
Mailing Address - Country:US
Mailing Address - Phone:505-986-2838
Mailing Address - Fax:505-986-2839
Practice Address - Street 1:2009 BOTULPH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1107
Practice Address - Country:US
Practice Address - Phone:505-986-2838
Practice Address - Fax:505-986-2839
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM923224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant