Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT.0004090 | CO |
NPI | 1013313121 |
---|---|
Provider Name | Mrs. Caroline Rubino |
First Address | Fort Collins, CO 80526-3167 |
Second Address | Windsor, CO 80550-3344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 30/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20673345 | (05) | CO |