Healthcare Provider Details

I. General information

NPI: 1972776565
Provider Name (Legal Business Name): PIKES PEAK OCCUPATIONAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 ROSS DR
COLORADO SPRINGS CO
80920-3311
US

IV. Provider business mailing address

7100 ROSS DR
COLORADO SPRINGS CO
80920-3311
US

V. Phone/Fax

Practice location:
  • Phone: 719-339-7673
  • Fax: 719-265-3029
Mailing address:
  • Phone: 719-339-7673
  • Fax: 719-265-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number996830
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT-1850
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE ANN MAXEY
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 719-339-7673