Healthcare Provider Details

I. General information

NPI: 1093601627
Provider Name (Legal Business Name): ALEXIS NICOLE BEDARD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E HARMONY RD STE 140160
FORT COLLINS CO
80525-3280
US

IV. Provider business mailing address

1650 LYNDON FARM CT STE 300
LOUISVILLE KY
40223-5005
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-1201
  • Fax: 800-675-0273
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0008900
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: