Provider Demographics
NPI:1316137466
Name:SAUCEDA, JANIS JEAN (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:JEAN
Last Name:SAUCEDA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1656 BOSQUE VISTA LOOP NW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-8322
Mailing Address - Country:US
Mailing Address - Phone:505-565-1651
Mailing Address - Fax:
Practice Address - Street 1:5201 ROMA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1334
Practice Address - Country:US
Practice Address - Phone:505-262-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1441224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant