1972776565 NPI number — PIKES PEAK OCCUPATIONAL THERAPY, INC.

Table of content: (NPI 1972776565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972776565 NPI number — PIKES PEAK OCCUPATIONAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIKES PEAK OCCUPATIONAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972776565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 ROSS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80920-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-339-7673
Provider Business Mailing Address Fax Number:
719-265-3029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 ROSS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80920-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-339-7673
Provider Business Practice Location Address Fax Number:
719-265-3029
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAXEY
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OCCUPATIONAL THERAPIST
Authorized Official Telephone Number:
719-339-7673

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  996830 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X , with the licence number: OT-1850 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 996830 . This is a "LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 05509556 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".