Facts
- Status
- A
- Credential
- MS, OTR/L
- Type
- Individual
- Enumeration date
- 2013-06-04
- Last updated
- 2023-01-18
Licenses
- License OR
- 1074566
- License AK
- 1860
- License CO
- OT.0004358
Location
- Practice location
- 29036 PINE RD
- City
- EVERGREEN CO
- Postal code
- 804397429
- Phone
- 303-709-8757
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.