Provider Demographics
NPI:1356372882
Name:SCHULTZ, NANCY J (OT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:RUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4750 W 120TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-3314
Mailing Address - Country:US
Mailing Address - Phone:303-603-9400
Mailing Address - Fax:303-603-9420
Practice Address - Street 1:4750 W 120TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3314
Practice Address - Country:US
Practice Address - Phone:303-603-9400
Practice Address - Fax:303-603-9420
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT-1669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO87820757Medicaid
COC807319Medicare PIN