Provider Demographics
NPI:1598036667
Name:JANICKE, JAMIE LEE (MS, OTR)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:JANICKE
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:TERPSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:1815 W DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1668
Mailing Address - Country:US
Mailing Address - Phone:970-691-1005
Mailing Address - Fax:
Practice Address - Street 1:1700 18TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5134
Practice Address - Country:US
Practice Address - Phone:970-313-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist