=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194401448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLORADO ORTHOTIC & PROSTHETIC SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2023
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 N 7TH ST
-----------------------------------------------------
City | GRAND JUNCTION
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81501-8117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-880-9760
-----------------------------------------------------
Fax | 970-880-9761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 W 5TH AVE
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-5105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-685-6520
-----------------------------------------------------
Fax | 720-685-6521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TIM O'NEILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-407-5408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------