MEDICARE: SANDRA C BOST

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	969609	CO

General Provider Information

NPI Number	:	1255316436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA C BOST

Provider Business Mailing Address
First Line	:	7310 S ALTON WAY
Second Line	:	STE 6L
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-2334
Country	:	US
Telephone Number	:	303-790-4495
Fax Number	:	720-488-1988

Provider Business Practice Location Address
First Line	:	2233 ACADEMY PL
Second Line	:	STE 50
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1696
Country	:	US
Telephone Number	:	719-475-0808
Fax Number	:	719-475-8822

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	03/31/2011

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