Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0004781 | CO |
NPI | 1063949022 |
---|---|
Provider Name | Ms. Lauren Petti |
First Address | Fort Collins, CO 80524-9021 |
Second Address | Greeley, CO 80631-4039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2017 |
Last Update Date | 21/05/2017 |