Provider Demographics
NPI:1568716371
Name:SODERLIND, TEGAN AYMOND (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TEGAN
Middle Name:AYMOND
Last Name:SODERLIND
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:TEGAN
Other - Middle Name:
Other - Last Name:AYMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:16891 RIVERVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81403-7484
Mailing Address - Country:US
Mailing Address - Phone:952-200-4710
Mailing Address - Fax:
Practice Address - Street 1:16891 RIVERVIEW CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81403-7484
Practice Address - Country:US
Practice Address - Phone:952-200-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO983225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist