Healthcare Provider Details

I. General information

NPI: 1427768688
Provider Name (Legal Business Name): EMILY GRIEB OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 ENDICOTT ST
FORT COLLINS CO
80524-3225
US

IV. Provider business mailing address

638 ENDICOTT ST
FORT COLLINS CO
80524-3225
US

V. Phone/Fax

Practice location:
  • Phone: 480-600-3156
  • Fax:
Mailing address:
  • Phone: 480-600-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0007730
License Number StateCO

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: