Healthcare Provider Details

I. General information

NPI: 1013518679
Provider Name (Legal Business Name): ANGELA NANCY SHAVER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-2517
US

IV. Provider business mailing address

2522 W SAINT VRAIN ST
COLORADO SPRINGS CO
80904-2517
US

V. Phone/Fax

Practice location:
  • Phone: 303-719-2273
  • Fax: 888-505-3617
Mailing address:
  • Phone: 303-719-2273
  • Fax: 888-505-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0000915
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: