Healthcare Provider Details

I. General information

NPI: 1487311395
Provider Name (Legal Business Name): ALPHA - OMEGA THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2021
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ELK TRL
WALSENBURG CO
81089-8556
US

IV. Provider business mailing address

34 ELK TRL
WALSENBURG CO
81089-8556
US

V. Phone/Fax

Practice location:
  • Phone: 719-994-0148
  • Fax:
Mailing address:
  • Phone: 719-994-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSH ALAN CORBIN
Title or Position: MEMBER
Credential: OTR/L
Phone: 719-994-0148