Provider Demographics
NPI:1811668080
Name:OELERICH, JOSEPH FRANCIS (MT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRANCIS
Last Name:OELERICH
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 88TH AVE APT F114
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-8409
Mailing Address - Country:US
Mailing Address - Phone:970-274-6177
Mailing Address - Fax:
Practice Address - Street 1:13913 COUNTY ROAD 20
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-9501
Practice Address - Country:US
Practice Address - Phone:303-704-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist