Provider Demographics
NPI:1306090907
Name:BLECHER, LILLY-MARIE MAITA (ND, DOM)
Entity type:Individual
Prefix:DR
First Name:LILLY-MARIE
Middle Name:MAITA
Last Name:BLECHER
Suffix:
Gender:F
Credentials:ND, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 GUSDORF RD STE O
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6298
Mailing Address - Country:US
Mailing Address - Phone:575-776-7806
Mailing Address - Fax:575-613-7161
Practice Address - Street 1:1337 GUSDORF RD STE O
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6298
Practice Address - Country:US
Practice Address - Phone:575-776-7806
Practice Address - Fax:575-613-7161
Is Sole Proprietor?:No
Enumeration Date:2008-11-09
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist