Provider Demographics
NPI:1205350311
Name:PATTON, JUDITH LEE (OTR/L)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:LEE
Last Name:PATTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:LEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:113 HAWK DRIVE
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528-0547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:232 ALPINE DR
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9557
Practice Address - Country:US
Practice Address - Phone:575-759-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO208829225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOT.0000520OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES