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NPI Code Detail

MEDICARE: JENNY WITTEVELD

MEDICARE: JENNY WITTEVELD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist0001234CO

General Provider Information

NPI Number : 1730511072
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNY WITTEVELD
Provider Business Mailing Address
First Line : 5055 S LEMAY AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-9401
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5055 S LEMAY AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-9401
Country : US
Telephone Number : 970-230-0880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2013
Last Update Date : 04/28/2014

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Directions to “ JENNY WITTEVELD ” Practice Location

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