Provider Demographics
NPI:1720142375
Name:LEE-WHATLEY, LUANN L (OT)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:L
Last Name:LEE-WHATLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 S HANOVER WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3733
Mailing Address - Country:US
Mailing Address - Phone:817-455-5251
Mailing Address - Fax:
Practice Address - Street 1:5751 S HANOVER WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3733
Practice Address - Country:US
Practice Address - Phone:817-455-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110153225X00000X, 225XP0200X
COOT.0002800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06185045Medicaid