Provider Demographics
NPI:1285407155
Name:HAZZARD, LYDIA MARIE (MOTR/L)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:MARIE
Last Name:HAZZARD
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MARIE
Other - Last Name:BRUBAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:1602 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-1889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 SOPRIS AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2038
Practice Address - Country:US
Practice Address - Phone:970-384-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO377986225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist