Provider Demographics
NPI:1992179238
Name:GONDA, JAYNE (OTR)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:GONDA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 W DRAKE RD STE 133A
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5567
Mailing Address - Country:US
Mailing Address - Phone:970-494-6449
Mailing Address - Fax:970-494-6447
Practice Address - Street 1:802 W DRAKE RD STE 133A
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5567
Practice Address - Country:US
Practice Address - Phone:970-494-6449
Practice Address - Fax:970-494-6447
Is Sole Proprietor?:No
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist