MEDICARE: BRAINTRUST SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1174154959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAINTRUST SERVICES

Provider Business Mailing Address
First Line	:	2850 MCCLELLAND DR STE 3000I
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	409-739-2607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3000I
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	409-739-2607
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW DODSON
Credential	:	OTR/L
Telephone Number	:	409-739-2607

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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