Provider Demographics
NPI:1629232467
Name:KLCO, JANET GAIL (CMT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:GAIL
Last Name:KLCO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:10001 CR 12
Mailing Address - City:COTOPAXI
Mailing Address - State:CO
Mailing Address - Zip Code:81223-0338
Mailing Address - Country:US
Mailing Address - Phone:719-942-4178
Mailing Address - Fax:719-942-4178
Practice Address - Street 1:1015 W. 3RD STREET
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201
Practice Address - Country:US
Practice Address - Phone:719-207-3972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist