Provider Demographics
NPI:1710548508
Name:TRETIAK, OKSANA (MOTR/L)
Entity Type:Individual
Prefix:
First Name:OKSANA
Middle Name:
Last Name:TRETIAK
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 SAN MATEO BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2313
Mailing Address - Country:US
Mailing Address - Phone:505-302-6850
Mailing Address - Fax:505-672-5137
Practice Address - Street 1:9550 SAN MATEO BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2313
Practice Address - Country:US
Practice Address - Phone:505-302-6850
Practice Address - Fax:505-672-5137
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4077225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics