Provider Demographics
NPI:1528225190
Name:LO, JENNIFER (OTR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LO
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 1:962 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4834
Mailing Address - Country:US
Mailing Address - Phone:720-323-5621
Mailing Address - Fax:303-482-2467
Practice Address - Street 1:14554 MAJESTIC EAGLE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-9622
Practice Address - Country:US
Practice Address - Phone:720-323-5621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
COOT.0001862225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171W00000XOther Service ProvidersContractor