MEDICARE: ILIA SRYGLEY OTR

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	0003664	CO
2	225XP0200X	Pediatric Occupational Therapist	112573	TX

General Provider Information

NPI Number	:	1245497353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIA SRYGLEY OTR

Provider Business Mailing Address
First Line	:	2127 BALDWIN ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-7074
Country	:	US
Telephone Number	:	214-543-0581
Fax Number	:

Provider Business Practice Location Address
First Line	:	4650 ROYAL VISTA CIR
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80528-9321
Country	:	US
Telephone Number	:	970-305-5070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2008
Last Update Date	:	03/17/2018

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Directions to “ ILIA SRYGLEY OTR” Practice Location

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