Provider Demographics
NPI:1124186416
Name:DELAWARE, JUDY (OTRL)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:DELAWARE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 W ENCLAVE CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2902
Mailing Address - Country:US
Mailing Address - Phone:303-898-9339
Mailing Address - Fax:303-379-6909
Practice Address - Street 1:1139 W ENCLAVE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-2902
Practice Address - Country:US
Practice Address - Phone:303-898-9339
Practice Address - Fax:303-379-6909
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3290-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69129231Medicaid
CO25475533Medicaid