Healthcare Provider Details

I. General information

NPI: 1467590927
Provider Name (Legal Business Name): DOUGLAS A OLMSTED OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 S BANNOCK ST
ENGLEWOOD CO
80110-3606
US

IV. Provider business mailing address

3715 S BANNOCK ST
ENGLEWOOD CO
80110-3606
US

V. Phone/Fax

Practice location:
  • Phone: 303-761-4626
  • Fax: 303-761-4626
Mailing address:
  • Phone: 303-761-4626
  • Fax: 303-761-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberNBCOT CERT AA524686
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: