Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XH1200X | Occupational Therapist - Hand | OC001797 | PA |
Y | 225XH1200X | Occupational Therapist - Hand | OT.0001431 | CO |
NPI | 1003964495 |
---|---|
Provider Name | Ms. Luann Good-Decurnou |
First Address | Golden, CO 80403-2076 |
Second Address | Westminster, CO 80023-9328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 12/02/2019 |