Provider Demographics
NPI:1043325913
Name:HOERSKE, MEREDITH EVE (OTR/L)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:EVE
Last Name:HOERSKE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:555 MANHATTAN DR UNIT 203
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4079
Mailing Address - Country:US
Mailing Address - Phone:303-931-5445
Mailing Address - Fax:720-664-6504
Practice Address - Street 1:3775 IRIS AVE STE 2A&B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2043
Practice Address - Country:US
Practice Address - Phone:813-431-3702
Practice Address - Fax:720-664-6504
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOT10327OtherLICENSE #
COOT.0001866OtherCO STATE LICENSE