Provider Demographics
NPI:1366713141
Name:JURINAK LONG, VICTORIA (OTR)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:JURINAK LONG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7983 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2454
Mailing Address - Country:US
Mailing Address - Phone:303-697-4726
Mailing Address - Fax:
Practice Address - Street 1:7983 SURREY DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-2454
Practice Address - Country:US
Practice Address - Phone:303-697-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2237225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics