Healthcare Provider Details

I. General information

NPI: 1619119435
Provider Name (Legal Business Name): AMY ELIZABETH VANDERVEER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E GEORGIA AVE
GUNNISON CO
81230-2256
US

IV. Provider business mailing address

353 MEADOW LARK TRL
GUNNISON CO
81230-9229
US

V. Phone/Fax

Practice location:
  • Phone: 970-641-2908
  • Fax:
Mailing address:
  • Phone: 307-899-6517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0006107
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013
License Number StateWY

VII. Legacy identifiers

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

# 1
IdentifierMSAHR0399
Identifier TypeMEDICAID
Identifier StateWY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: