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General NPI Number Information
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NPI Number | 1386821825
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Entity Type | Organization
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Legal Business Name | RED WILLOW OCCUPATIONAL MYOFASCIAL
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 823 S PERRY ST SUITE 260
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City | CASTLE ROCK
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State | CO
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Zip | 80104-1900
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Country | US
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Telephone | 303-902-8476
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Fax | 303-265-9515
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Provider Business Mailing Address
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Address Line | 823 S PERRY ST SUITE 260
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City | CASTLE ROCK
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State | CO
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Zip | 80104-1900
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Country | US
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Telephone | 303-902-8476
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Fax | 303-265-9515
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JULIANN HANSON-ZLATEV
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Credential | OTR
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Telephone | 303-902-8476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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