Provider Demographics
NPI:1417429291
Name:LUND, REBECCA ELISE (OTR/L, CLT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELISE
Last Name:LUND
Suffix:
Gender:F
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:E
Other - Last Name:MCINTIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2139 GRAIN BIN DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3426
Mailing Address - Country:US
Mailing Address - Phone:970-342-6433
Mailing Address - Fax:
Practice Address - Street 1:1024 S LEMAY AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3929
Practice Address - Country:US
Practice Address - Phone:970-495-8428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3634225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist