MEDICARE: PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC

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	225XP0200X	Pediatric Occupational Therapist	OT.0001390	CO

General Provider Information

NPI Number	:	1265850960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2125 SHEFFIELD DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1638
Country	:	US
Telephone Number	:	970-493-1115
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 W DRAKE RD STE B8
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6031
Country	:	US
Telephone Number	:	970-215-9693
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	MRS. KATHLEEN BINGAMAN
Credential	:	OTR
Telephone Number	:	970-215-9693

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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