Provider Demographics
NPI:1033887989
Name:DURHAM, JESSIE AILEEN (CTRS)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:AILEEN
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. WHEELING ST
Mailing Address - Street 2:117 - RECREATION THERAPY
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:720-527-8066
Mailing Address - Fax:
Practice Address - Street 1:1700 N. WHEELING ST
Practice Address - Street 2:117 - RECREATION THERAPY
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:720-527-8066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist