Healthcare Provider Details

I. General information

NPI: 1427599448
Provider Name (Legal Business Name): JEANETTE ANN-JANES ESPARSEN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 06/28/2020
Certification Date: 06/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 ALLENDALE DR.
PEYTON CO
80831-6834
US

IV. Provider business mailing address

4445 N CAREFREE CIR
COLORADO SPRINGS CO
80917-2113
US

V. Phone/Fax

Practice location:
  • Phone: 719-337-7408
  • Fax:
Mailing address:
  • Phone: 719-337-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0004924
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: