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General NPI Number Information
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NPI Number | 1184375131
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Entity Type | Individual
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Provider Name | SOMMER WILDER MORENO OT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 4700 HALE PKWY
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City | DENVER
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State | CO
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Zip | 80220-4045
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Country | US
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Telephone | 806-690-6146
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Fax |
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Provider Business Mailing Address
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Address Line | 4397 S FOX ST
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City | ENGLEWOOD
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State | CO
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Zip | 80110-5616
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Country | US
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Telephone | 806-690-6146
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0007231
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License Number State | CO
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