Healthcare Provider Details

I. General information

NPI: 1003467820
Provider Name (Legal Business Name): AMY SIMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S PRAIRIE AVE
PUEBLO CO
81005-2307
US

IV. Provider business mailing address

2818 MORRIS AVE
PUEBLO CO
81003-1336
US

V. Phone/Fax

Practice location:
  • Phone: 719-569-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: