Provider Demographics
NPI:1578086344
Name:RUDOLF, MICHELLE (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8898 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2600
Mailing Address - Country:US
Mailing Address - Phone:303-387-6609
Mailing Address - Fax:
Practice Address - Street 1:620 WILCOX ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1739
Practice Address - Country:US
Practice Address - Phone:303-387-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005666225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist