Healthcare Provider Details

I. General information

NPI: 1790699783
Provider Name (Legal Business Name): RISE PEDIATRIC THERAPY CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E COUNTY ROAD 56
FORT COLLINS CO
80524-9523
US

IV. Provider business mailing address

451 E COUNTY ROAD 56
FORT COLLINS CO
80524-9523
US

V. Phone/Fax

Practice location:
  • Phone: 970-222-4620
  • Fax:
Mailing address:
  • Phone: 970-222-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HEATHER N VAUGHN
Title or Position: CEO
Credential: MS OTRL
Phone: 970-222-4620