Facts
- Status
- A
- Credential
- OTR-L
- Type
- Individual
- Enumeration date
- 2007-06-01
- Last updated
- 2016-07-21
Specialties
Licenses
- License CO
- 1052910
Location
- Practice location
- 5814 HIGHWAY 348
- City
- OLATHE CO
- Postal code
- 814259714
- Phone
- 970-323-5400
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.