Healthcare Provider Details

I. General information

NPI: 1588956841
Provider Name (Legal Business Name): WILLIAM G WESTERGARD MAOTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S EATON ST
LAKEWOOD CO
80226-3544
US

IV. Provider business mailing address

29571 FAIRWAY DR
EVERGREEN CO
80439-7460
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-1448
  • Fax:
Mailing address:
  • Phone: 720-261-1205
  • Fax: 303-320-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: