Provider Demographics
NPI:1881129401
Name:ROLLE, NATALIE ROSE (MOT OTR/L)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ROSE
Last Name:ROLLE
Suffix:
Gender:F
Credentials:MOT OTR/L
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:ROSE
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT OTR/L
Mailing Address - Street 1:1131 MCHUGH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4341
Mailing Address - Country:US
Mailing Address - Phone:507-261-9116
Mailing Address - Fax:
Practice Address - Street 1:800 OVAL DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004284225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist