Provider Demographics
NPI:1093913857
Name:WOLLERT, NADELLE (DELL) OPAL (OTR)
Entity Type:Individual
Prefix:MS
First Name:NADELLE (DELL)
Middle Name:OPAL
Last Name:WOLLERT
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 1:7382 COUNTY ROAD MM
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-9603
Mailing Address - Country:US
Mailing Address - Phone:719-336-0364
Mailing Address - Fax:
Practice Address - Street 1:205 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2622
Practice Address - Country:US
Practice Address - Phone:719-336-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO982042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist