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General NPI Number Information
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NPI Number | 1548222342
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Entity Type | Individual
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Provider Name | MARLIS J LANE OTR CDRS
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Gender | Female
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 1045 ROBERTSON ST
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City | FORT COLLINS
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State | CO
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Zip | 80524-3926
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Country | US
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Telephone | 970-493-6667
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Fax | 970-493-8016
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Provider Business Mailing Address
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Address Line | 1814 W VINE DR
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City | FORT COLLINS
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State | CO
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Zip | 80521-1621
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Country | US
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Telephone | 970-482-8923
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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 | AA635391
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 225XR0403X
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Taxonomy Name | Driving and Community Mobility Occupational Therapist
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License Number | AA635391
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License Number State | CO
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