MEDICARE: DR. KENDALL ADELE HORAN OTD, 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

General Provider Information

NPI Number	:	1376113423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDALL ADELE HORAN OTD, OTR

Provider Business Mailing Address
First Line	:	12477 VENTANA MESA CIR
Second Line	:
City	:	CASTLE PINES
State	:	CO
Zip	:	80108-9150
Country	:	US
Telephone Number	:	303-522-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 LIMON DR UNIT D12
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-7662
Country	:	US
Telephone Number	:	303-522-6830
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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