Provider Demographics
NPI:1588863864
Name:BRENDA J PARDY OTR LLC
Entity type:Organization
Organization Name:BRENDA J PARDY OTR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OTR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-649-9007
Mailing Address - Street 1:6535 S DAYTON ST STE 3800
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6535 S DAYTON ST STE 3800
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-6181
Practice Address - Country:US
Practice Address - Phone:303-649-9007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21053537Medicaid
COC487658Medicare ID - Type Unspecified