Healthcare Provider Details

I. General information

NPI: 1538436043
Provider Name (Legal Business Name): LINDSAY HEPP OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2011
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 RIVER PARK DR.
RIDGWAY CO
81432
US

IV. Provider business mailing address

605 RIVER PARK DR
RIDGWAY CO
81432-8711
US

V. Phone/Fax

Practice location:
  • Phone: 970-318-1487
  • Fax:
Mailing address:
  • Phone: 970-318-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number266591
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: