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General NPI Number Information
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NPI Number | 1629726872
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Entity Type | Individual
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Provider Name | JOLENE VERGAUWEN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 6800 LEETSDALE DR
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City | DENVER
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State | CO
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Zip | 80224-1588
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Country | US
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Telephone | 303-331-9968
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Fax |
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Provider Business Mailing Address
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Address Line | 11757 E 25TH AVE UNIT 7204
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City | AURORA
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State | CO
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Zip | 80010-1297
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Country | US
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Telephone | 407-575-9138
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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 | OT.0007304
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License Number State | CO
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