Provider Demographics
NPI:1205955143
Name:GIRMUS, MARIAN M (OTRL)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:M
Last Name:GIRMUS
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:3 CALIENTE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9208
Mailing Address - Country:US
Mailing Address - Phone:505-436-1163
Mailing Address - Fax:505-636-5172
Practice Address - Street 1:3 CALIENTE RD
Practice Address - Street 2:STE 6
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9208
Practice Address - Country:US
Practice Address - Phone:505-603-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85502219Medicaid