Individual
MRS. LYNN ELLEN MONDRAGON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
4601 EAGLERIDGE PL STE 140, PUEBLO, CO 81008-4101
(719) 253-7727
(719) 253-7729
Mailing address
4601 EAGLERIDGE PL STE 140, PUEBLO, CO 81008-4101
(719) 253-7727
(719) 253-7729
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.0001038
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831338516
CLINIC NPI
—
Enumeration date
04/02/2018
Last updated
04/02/2018
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