Healthcare Provider Details

I. General information

NPI: 1013846310
Provider Name (Legal Business Name): INTEGRATIVE WELLNESS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14477 COUNTY ROAD 501
BAYFIELD CO
81122-8858
US

IV. Provider business mailing address

14477 COUNTY ROAD 501
BAYFIELD CO
81122-8858
US

V. Phone/Fax

Practice location:
  • Phone: 678-294-9173
  • Fax:
Mailing address:
  • Phone: 678-294-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DAHLENBURG
Title or Position: OTR/L
Credential:
Phone: 678-294-9173