Provider Demographics
NPI:1528284502
Name:JIMENEZ, BRIAN LEN (OTD, OTRL, CCI)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEN
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:OTD, OTRL, CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 DUNBAR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2279
Mailing Address - Country:US
Mailing Address - Phone:970-282-0258
Mailing Address - Fax:
Practice Address - Street 1:2807 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2279
Practice Address - Country:US
Practice Address - Phone:970-282-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist