Provider Demographics
NPI:1730401118
Name:BOLANOS-NAUTH, LIZETTE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LIZETTE
Middle Name:
Last Name:BOLANOS-NAUTH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:LIZETTE
Other - Middle Name:
Other - Last Name:BOLANOS-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:215 FOX DR
Mailing Address - Street 2:206
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-3529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 FOX DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3529
Practice Address - Country:US
Practice Address - Phone:617-710-2975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2016-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3359225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist