Healthcare Provider Details

I. General information

NPI: 1730699430
Provider Name (Legal Business Name): RISING FROM ASHES OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 10/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 W HAMPDEN AVE STE 300
ENGLEWOOD CO
80110-2199
US

IV. Provider business mailing address

7446 E LONG CIR
CENTENNIAL CO
80112-2657
US

V. Phone/Fax

Practice location:
  • Phone: 303-919-0517
  • Fax:
Mailing address:
  • Phone: 303-919-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDITH L HAVERLAND
Title or Position: SOLE MEMBER/OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 303-919-0517