Individual
CONSTANCE RUSSELL LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MAOTR
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
Update your record
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