Healthcare Provider Details

I. General information

NPI: 1962120873
Provider Name (Legal Business Name): PRESTIGE THERAPEUTIC EQUESTRIAN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 BOSTON ST
BRIGHTON CO
80602-5600
US

IV. Provider business mailing address

15650 BOSTON ST
BRIGHTON CO
80602-5600
US

V. Phone/Fax

Practice location:
  • Phone: 303-359-2217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELSEY GALLAGHER
Title or Position: OWNER
Credential: COTA/L
Phone: 303-359-2217