Healthcare Provider Details

I. General information

NPI: 1710616743
Provider Name (Legal Business Name): EARLY INTERVENTION PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22811 COUNTY ROAD 36
STERLING CO
80751-9207
US

IV. Provider business mailing address

22811 COUNTY ROAD 36
STERLING CO
80751-9207
US

V. Phone/Fax

Practice location:
  • Phone: 970-520-3625
  • Fax:
Mailing address:
  • Phone: 970-520-3625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE KAISER
Title or Position: OWNER
Credential: MA, OTR
Phone: 970-520-3625