MEDICARE: MS. MICHELLE ANN GOSS 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	225XP0200X	Pediatric Occupational Therapist	AA460303	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285848531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ANN GOSS OTR

Provider Business Mailing Address
First Line	:	5858 S FULTON WAY
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3720
Country	:	US
Telephone Number	:	303-694-3585
Fax Number	:	720-250-0289

Provider Business Practice Location Address
First Line	:	5858 S FULTON WAY
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-3720
Country	:	US
Telephone Number	:	303-694-3585
Fax Number	:	720-250-0289

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/09/2007

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