Provider Demographics
NPI:1093153348
Name:BRUCKER, TAYLOR LOUISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LOUISE
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 24TH STREET
Mailing Address - Street 2:APARTMENT 522
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205
Mailing Address - Country:US
Mailing Address - Phone:309-287-2184
Mailing Address - Fax:
Practice Address - Street 1:8301 EAST PRENTICE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-322-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3725225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22Medicare PIN