Provider Demographics
NPI:1134750508
Name:LIVE WELL OCCUPATIONAL THERAPY LLC
Entity type:Organization
Organization Name:LIVE WELL OCCUPATIONAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:302-593-6282
Mailing Address - Street 1:30772 SOUTHVIEW DR STE 140
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-2214
Mailing Address - Country:US
Mailing Address - Phone:303-704-4578
Mailing Address - Fax:
Practice Address - Street 1:30772 SOUTHVIEW DR STE 140
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-2214
Practice Address - Country:US
Practice Address - Phone:303-704-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty