Healthcare Provider Details

I. General information

NPI: 1699139907
Provider Name (Legal Business Name): LAURA BACHMAN-MAU OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 N ACADEMY BLVD SUITE 227
COLORADO SPRINGS CO
80917-5337
US

IV. Provider business mailing address

2005 AEROPLAZA DR
COLORADO SPRINGS CO
80916-4207
US

V. Phone/Fax

Practice location:
  • Phone: 719-425-7771
  • Fax: 719-208-7730
Mailing address:
  • Phone: 719-425-7771
  • Fax: 719-208-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0004332
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: