Healthcare Provider Details

I. General information

NPI: 1841873981
Provider Name (Legal Business Name): NOCO PEDIATRIC OT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E COUNTY ROAD 40
FORT COLLINS CO
80525-9009
US

IV. Provider business mailing address

4650 ROYAL VISTA CIR STE 100
WINDSOR CO
80528-9321
US

V. Phone/Fax

Practice location:
  • Phone: 970-305-5070
  • Fax:
Mailing address:
  • Phone: 970-305-5070
  • Fax: 970-541-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TANEAL BEHM
Title or Position: OWNER
Credential:
Phone: 970-305-5070