Provider Demographics
NPI:1588970818
Name:DUBAS, TODD P (COTA/L)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:P
Last Name:DUBAS
Suffix:
Gender:M
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 1:4008 N GRIMES ST # 247
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-0903
Mailing Address - Country:US
Mailing Address - Phone:505-507-2424
Mailing Address - Fax:575-433-0607
Practice Address - Street 1:1019 E BENDER BLVD
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-2415
Practice Address - Country:US
Practice Address - Phone:575-433-0600
Practice Address - Fax:575-433-0607
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2396224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant