Provider Demographics
NPI:1194173088
Name:SYED, SALIM M (COTA)
Entity type:Individual
Prefix:MR
First Name:SALIM
Middle Name:M
Last Name:SYED
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 1:5928 ERMEMIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5993
Mailing Address - Country:US
Mailing Address - Phone:505-313-6928
Mailing Address - Fax:
Practice Address - Street 1:5928 ERMEMIN AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5993
Practice Address - Country:US
Practice Address - Phone:505-313-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213257224Z00000X
NM3320224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant