Provider Demographics
NPI:1730723347
Name:DEAN, JONATHON LEIGH
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:LEIGH
Last Name:DEAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 PORTLAND PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-8220
Mailing Address - Country:US
Mailing Address - Phone:505-239-9647
Mailing Address - Fax:
Practice Address - Street 1:1153 PORTLAND PL APT 2
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-8220
Practice Address - Country:US
Practice Address - Phone:505-239-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0008534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist