Provider Demographics
NPI:1184880494
Name:PAVLOVIC, MICHELE DENISE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:PAVLOVIC
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:DENISE
Other - Last Name:BUBNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:19589 W 59TH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-2212
Mailing Address - Country:US
Mailing Address - Phone:901-210-3924
Mailing Address - Fax:
Practice Address - Street 1:600 GOLDEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-8916
Practice Address - Country:US
Practice Address - Phone:720-222-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TN1262225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist