Provider Demographics
NPI:1730529298
Name:ST GERMAIN, CHARLENE T (MOTR/L)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:T
Last Name:ST GERMAIN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 ESPANOLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3523
Mailing Address - Country:US
Mailing Address - Phone:505-884-0953
Mailing Address - Fax:
Practice Address - Street 1:2828 ESPANOLA ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3523
Practice Address - Country:US
Practice Address - Phone:505-884-0953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3043225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist