Provider Demographics
NPI:1245497353
Name:SRYGLEY, ILIA (OTR)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:
Last Name:SRYGLEY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:ILIA
Other - Middle Name:
Other - Last Name:LOWRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2127 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7074
Mailing Address - Country:US
Mailing Address - Phone:214-543-0581
Mailing Address - Fax:
Practice Address - Street 1:4650 ROYAL VISTA CIR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-9321
Practice Address - Country:US
Practice Address - Phone:970-305-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003664225X00000X
TX112573225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics