Provider Demographics
NPI:1528214509
Name:GURULE, LUDIVINA OPHELIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:LUDIVINA
Middle Name:OPHELIA
Last Name:GURULE
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 1:1102 LE ANN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-1061
Mailing Address - Country:US
Mailing Address - Phone:575-622-4206
Mailing Address - Fax:575-622-4206
Practice Address - Street 1:313 W 2ND ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4609
Practice Address - Country:US
Practice Address - Phone:575-622-4206
Practice Address - Fax:575-622-4206
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist