Provider Demographics
NPI:1164172318
Name:HERKLOTZ, LYNN MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:HERKLOTZ
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 1:715 MERRY LN
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-9712
Mailing Address - Country:US
Mailing Address - Phone:303-931-3469
Mailing Address - Fax:
Practice Address - Street 1:17351 DRAKE ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-5205
Practice Address - Country:US
Practice Address - Phone:303-908-0500
Practice Address - Fax:720-465-9320
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist