Individual
CONSTANCE RUSSELL LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAOTR
Contact information
Practice address
8792 E MINERAL CIR, CENTENNIAL, CO 80112-2748
(303) 809-4058
Mailing address
8792 E MINERAL CIR, CENTENNIAL, CO 80112-2748
(303) 809-4058
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2362
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2362
COLORADO STATE LICENSE
CO
01
—
AA407379
NBCOT
—
Enumeration date
07/18/2013
Last updated
07/18/2013
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