Provider Demographics
NPI:1679643662
Name:SINNOTT-OSWALD, MARY E
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SINNOTT-OSWALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:OSWALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, OTR, CHT
Mailing Address - Street 1:585 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4366
Mailing Address - Country:US
Mailing Address - Phone:970-247-9128
Mailing Address - Fax:
Practice Address - Street 1:575 RIVERGATE
Practice Address - Street 2:SUITE 108
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-247-7711
Practice Address - Fax:970-247-1415
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
003444225X00000X
9410000282225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19124724Medicaid
COC45048Medicare ID - Type Unspecified
CO19124724Medicaid