Healthcare Provider Details

I. General information

NPI: 1063809184
Provider Name (Legal Business Name): LORI OLCOTT LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3056 S GENEVA ST
DENVER CO
80231-4731
US

IV. Provider business mailing address

3056 S GENEVA ST
DENVER CO
80231-4731
US

V. Phone/Fax

Practice location:
  • Phone: 303-746-5735
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number9992
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: