Provider Demographics
NPI:1295136554
Name:METZ, JANE KORENSTRA (MSOTR,L)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:KORENSTRA
Last Name:METZ
Suffix:
Gender:F
Credentials:MSOTR,L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1446
Mailing Address - Country:US
Mailing Address - Phone:616-635-1720
Mailing Address - Fax:
Practice Address - Street 1:3780 N GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2233
Practice Address - Country:US
Practice Address - Phone:970-663-3222
Practice Address - Fax:970-663-3227
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003354225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist