Healthcare Provider Details

I. General information

NPI: 1366713141
Provider Name (Legal Business Name): VICTORIA JURINAK LONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7983 SURREY DR
MORRISON CO
80465-2454
US

IV. Provider business mailing address

7983 SURREY DR
MORRISON CO
80465-2454
US

V. Phone/Fax

Practice location:
  • Phone: 303-697-4726
  • Fax:
Mailing address:
  • Phone: 303-697-4726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2237
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: