Healthcare Provider Details

I. General information

NPI: 1154191138
Provider Name (Legal Business Name): EMBRACE OCCUPATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7132 S WASHINGTON ST
CENTENNIAL CO
80122-1241
US

IV. Provider business mailing address

7132 S WASHINGTON ST
CENTENNIAL CO
80122-1241
US

V. Phone/Fax

Practice location:
  • Phone: 319-331-8191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ELLYN MILLER EVANS
Title or Position: CEO/OWNER
Credential: OTD, OTR/L
Phone: 319-331-8191