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General NPI Number Information
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NPI Number | 1043442296
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Entity Type | Individual
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Provider Name | LARA DANIELLE D'ORVILLIERS M.ED, ATC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 9000 YORK ST
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City | THORNTON
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State | CO
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Zip | 80229-4659
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Country | US
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Telephone | 303-853-1244
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Fax | 303-853-1295
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Provider Business Mailing Address
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Address Line | 9000 YORK ST
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City | THORNTON
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State | CO
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Zip | 80229-4659
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Country | US
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Telephone | 303-853-1244
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Fax | 303-853-1295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00130900
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License Number State | NJ
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