Provider Demographics
NPI:1861183550
Name:CASTILLO, LANETTA (COTA/L)
Entity type:Individual
Prefix:
First Name:LANETTA
Middle Name:
Last Name:CASTILLO
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 1:9219 SILVER MESA ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6609
Mailing Address - Country:US
Mailing Address - Phone:505-453-1759
Mailing Address - Fax:
Practice Address - Street 1:10320 COTTONWOOD PARK NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-7008
Practice Address - Country:US
Practice Address - Phone:505-250-5204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOTA3230224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant