=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003142878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KELLI BIEL-KAUTZ OCCUPATIONAL THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2009
-----------------------------------------------------
Last Update Date | 07/29/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2656 THRUSH GRV
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-5909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-265-2515
-----------------------------------------------------
Fax | 866-586-4505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2656 THRUSH GRV
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-5909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-265-2515
-----------------------------------------------------
Fax | 866-586-4505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | KELLIE BIEL-KAUTZ
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 719-265-2515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 978949
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 978949
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------