Healthcare Provider Details

I. General information

NPI: 1487999280
Provider Name (Legal Business Name): JOSH A CORBIN OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2012
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ELK TRL
WALSENBURG CO
81089-8556
US

IV. Provider business mailing address

PO BOX 108
WALSENBURG CO
81089-0108
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1110
  • Fax:
Mailing address:
  • Phone: 719-994-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1327
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: