Healthcare Provider Details

I. General information

NPI: 1740482470
Provider Name (Legal Business Name): DALE M ULRICH OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 VILLAGE RD
CARBONDALE CO
81623-1564
US

IV. Provider business mailing address

821 LATIGO LOOP
CARBONDALE CO
81623-1589
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-1500
  • Fax: 970-963-9507
Mailing address:
  • Phone: 970-928-3226
  • Fax: 970-928-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: