MEDICARE: WILLOW TREE STUDIOS, 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	174H00000X	Health Educator
2	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1629788344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW TREE STUDIOS, LLC

Provider Business Mailing Address
First Line	:	2707 ANTELOPE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9679
Country	:	US
Telephone Number	:	970-449-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 ANTELOPE RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-9679
Country	:	US
Telephone Number	:	970-449-3460
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YVONNE HANNING
Credential	:
Telephone Number	:	970-449-3460

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	12/05/2022

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