Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 887 | CO |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 887 | CO |
N | 225XP0200X | Occupational Therapist - Pediatrics | 887 | CO |
NPI | 1295041721 |
---|---|
Provider Name | Ms. Tanya Layne Travis |
First Address | Grand Junction, CO 81501-6556 |
Second Address | Grand Junction, CO 81501-6556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2010 |
Last Update Date | 21/08/2010 |