=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437344629
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECIALIZED REHABILITATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 W CROSS DR SUITE 400
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-904-8133
-----------------------------------------------------
Fax | 303-904-8109
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9200 W CROSS DR SUITE 400
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-2239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-904-8133
-----------------------------------------------------
Fax | 303-904-8109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. RENEE MARIE TEBON
-----------------------------------------------------
Credential | OT, CHT
-----------------------------------------------------
Telephone | 303-904-8133
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 003122
-----------------------------------------------------
License Number State |
-----------------------------------------------------