Individual
JILLENE MCMINN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1145 E 13TH AVE, BROOMFIELD, CO 80020-1301
(303) 466-6308
(303) 466-1224
Mailing address
1145 E 13TH AVE, BROOMFIELD, CO 80020-1301
(303) 466-6308
(303) 466-1224
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0278321
CO
225X00000X
Occupational Therapist
Primary
AA439869
CO
Other
Enumeration date
08/14/2008
Last updated
08/14/2008
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