Healthcare Provider Details

I. General information

NPI: 1144407289
Provider Name (Legal Business Name): JUDITH A SANBORN O.T.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 HANCOCK DR
FORT COLLINS CO
80526-9658
US

IV. Provider business mailing address

6803 HANCOCK DR
FORT COLLINS CO
80526-9658
US

V. Phone/Fax

Practice location:
  • Phone: 970-277-1805
  • Fax:
Mailing address:
  • Phone: 970-277-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: