Individual
COLTON JAMES JORGENSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3100 OLYMPUS BLVD STE 500, COPPELL, TX 75019-5473
(866) 221-5405
Mailing address
155 SHERWOOD CIR, CASPER, WY 82609-3562
(307) 277-6219
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OTA-1398
WY
224Z00000X
Occupational Therapy Assistant
Primary
—
CA
Other
Enumeration date
04/03/2019
Last updated
04/03/2019
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