Provider Demographics
NPI:1629726872
Name:VERGAUWEN, JOLENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:VERGAUWEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11757 E 25TH AVE UNIT 7204
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1297
Mailing Address - Country:US
Mailing Address - Phone:407-575-9138
Mailing Address - Fax:
Practice Address - Street 1:6800 LEETSDALE DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1588
Practice Address - Country:US
Practice Address - Phone:303-331-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007304225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist