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General NPI Number Information
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NPI Number | 1629699178
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Entity Type | Individual
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Provider Name | MANDI LYNN WADE OTR
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Gender | Female
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Dates
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Enumeration Date | 05/06/2020
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 2430 RESEARCH PKWY STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-1093
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Country | US
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Telephone | 719-623-1050
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Fax | 719-562-6225
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Provider Business Mailing Address
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Address Line | 8101 E LOWRY BLVD STE 120
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City | DENVER
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State | CO
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Zip | 80230-7195
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Country | US
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Telephone | 720-865-6072
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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 | OTH-008088
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0006861
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License Number State | CO
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