Provider Demographics
NPI:1497128581
Name:AXTELL, OKTOBRE MORTICIA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:OKTOBRE
Middle Name:MORTICIA MICHELLE
Last Name:AXTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:OKTOBRE
Other - Middle Name:MORTICIA MICHELLE
Other - Last Name:FOETUSGRUBBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1610 N EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1412
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1610 N EMERSON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1412
Practice Address - Country:US
Practice Address - Phone:303-832-0742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician