Provider Demographics
NPI:1972932887
Name:NARDELL, LORENE (OTR)
Entity type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:NARDELL
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 1:4501 NELSON RD
Mailing Address - Street 2:#2204
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9432
Mailing Address - Country:US
Mailing Address - Phone:303-641-0963
Mailing Address - Fax:
Practice Address - Street 1:4501 NELSON RD
Practice Address - Street 2:#2204
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9432
Practice Address - Country:US
Practice Address - Phone:303-641-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001554225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist