Provider Demographics
NPI:1336615285
Name:LALANDE, MARILYN LEIGH (OTD, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LEIGH
Last Name:LALANDE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TEDMON DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-1750
Mailing Address - Country:US
Mailing Address - Phone:303-809-6657
Mailing Address - Fax:
Practice Address - Street 1:2118 LONGFIN CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3344
Practice Address - Country:US
Practice Address - Phone:970-590-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005601225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist