Provider Demographics
NPI:1205311552
Name:OAKES, JENNIFER RACHEL
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RACHEL
Last Name:OAKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 PROSPECT PARK WAY STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9707
Mailing Address - Country:US
Mailing Address - Phone:970-377-9401
Mailing Address - Fax:
Practice Address - Street 1:1613 PROSPECT PARK WAY STE 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9707
Practice Address - Country:US
Practice Address - Phone:970-377-9401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1467225XP0200X
COOT.0006183225XP0200X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics