Healthcare Provider Details

I. General information

NPI: 1114298353
Provider Name (Legal Business Name): SUSAN M MCCALLUM WINTERS OTR/L, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN M WINTERS OTR/L, CHT

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 LINCOLN AVE SUITE 200 C
STEAMBOAT SPRINGS CO
80487-3062
US

IV. Provider business mailing address

PO BOX 776087
STEAMBOAT SPRINGS CO
80477-6087
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-6556
  • Fax: 970-300-3112
Mailing address:
  • Phone: 970-846-5202
  • Fax: 970-300-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: