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General NPI Number Information
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NPI Number | 1487381943
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Entity Type | Individual
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Provider Name | LORI JORDAN
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 2939 DES MOINES DR
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City | FORT COLLINS
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State | CO
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Zip | 80525-6687
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Country | US
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Telephone | 970-818-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 8515 BLUFFTON RD
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City | FORT WAYNE
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State | IN
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Zip | 46809-3022
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Country | US
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Telephone | 260-207-5632
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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