Provider Demographics
NPI:1508043357
Name:DALE, LAURIE (COTA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:DALE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 MIRAMONT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1901
Mailing Address - Country:US
Mailing Address - Phone:970-472-1692
Mailing Address - Fax:
Practice Address - Street 1:1137 MIRAMONT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1901
Practice Address - Country:US
Practice Address - Phone:970-472-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant