Provider Demographics
NPI:1376212456
Name:MEDNICK, NATALIE R (COTA)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:R
Last Name:MEDNICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 S TRENTON ST APT 7
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2651
Mailing Address - Country:US
Mailing Address - Phone:203-641-8888
Mailing Address - Fax:
Practice Address - Street 1:1772 S TRENTON ST APT 7
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2651
Practice Address - Country:US
Practice Address - Phone:203-641-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001491225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics