Healthcare Provider Details

I. General information

NPI: 1417799446
Provider Name (Legal Business Name): OTTER CARE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 RIVERBEND AVE
FIRESTONE CO
80504-5368
US

IV. Provider business mailing address

5375 RIVERBEND AVE
FIRESTONE CO
80504-5368
US

V. Phone/Fax

Practice location:
  • Phone: 303-332-3418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CHARLOTTE ROSE CARY
Title or Position: LCSW, OWNER
Credential:
Phone: 303-332-3418