Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.0004491 | CO |
NPI | 1003280256 |
---|---|
Provider Name | Mrs. Tanya Renee Mander |
First Address | Loveland, CO 80537-2009 |
Second Address | Westminster, CO 80234-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2015 |
Last Update Date | 25/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348812 | NATIONAL BOARD CERTIFICATION IN OCCUPATIONAL THERAPY (NBCOT) (01) |