Healthcare Provider Details

I. General information

NPI: 1902158132
Provider Name (Legal Business Name): MARIEL LEIGH GOETTSCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 S COLLEGE AVE STE 301
FORT COLLINS CO
80525-1073
US

IV. Provider business mailing address

523 EDWARDS ST
FORT COLLINS CO
80524-3811
US

V. Phone/Fax

Practice location:
  • Phone: 970-900-6930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104228
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: