Provider Demographics
NPI:1093277089
Name:LANGE, MICHELLE LYNN (OTR/L, ABDA, ATP/SMS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:LANGE
Suffix:
Gender:F
Credentials:OTR/L, ABDA, ATP/SMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11785 W 56TH DR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-1413
Mailing Address - Country:US
Mailing Address - Phone:720-333-2661
Mailing Address - Fax:303-456-5905
Practice Address - Street 1:11785 W 56TH DR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1413
Practice Address - Country:US
Practice Address - Phone:720-333-2661
Practice Address - Fax:303-456-5905
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2019-04-01
Deactivation Date:2019-03-26
Deactivation Code:
Reactivation Date:2019-04-01
Provider Licenses
StateLicense IDTaxonomies
CO225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist