Provider Demographics
NPI:1467723346
Name:BOURDON, AMY GLASER (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:GLASER
Last Name:BOURDON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:THERESE
Other - Last Name:GLASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 SUNSHINE CT
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 SUNSHINE CT
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6064
Practice Address - Country:US
Practice Address - Phone:971-375-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1813225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist