Provider Demographics
NPI:1912142316
Name:ALDEA, VIRGINIA NICHOLLS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:NICHOLLS
Last Name:ALDEA
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 GILA CT
Mailing Address - Street 2:
Mailing Address - City:DEMING
Mailing Address - State:NM
Mailing Address - Zip Code:88030-8673
Mailing Address - Country:US
Mailing Address - Phone:575-545-1913
Mailing Address - Fax:575-546-0061
Practice Address - Street 1:111 N PEARL ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-3835
Practice Address - Country:US
Practice Address - Phone:575-544-4663
Practice Address - Fax:575-544-4665
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-14
Last Update Date:2008-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2427225X00000X
TX111412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist