Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | ||
N | 225X00000X | Occupational Therapist |
NPI | 1790996460 |
---|---|
Provider Name | Christa Pavlus |
First Address | Frederick, CO 80504-9690 |
Second Address | Louisville, CO 80027-2325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |