Healthcare Provider Details

I. General information

NPI: 1114592110
Provider Name (Legal Business Name): OWN YOUR MOTHERHOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 N YORK ST
DENVER CO
80205-4662
US

IV. Provider business mailing address

2651 N YORK ST
DENVER CO
80205-4662
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-5345
  • Fax:
Mailing address:
  • Phone: 208-201-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANNIE CLOSE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT
Phone: 208-201-5345