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General NPI Number Information
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NPI Number | 1568847580
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Entity Type | Organization
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Legal Business Name | COLORADO OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 34520 HIGHWAY 6 #C17
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City | EDWARDS
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State | CO
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Zip | 81632-5033
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Country | US
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Telephone | 616-635-1720
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5033
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City | EDWARDS
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State | CO
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Zip | 81632-5033
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Country | US
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Telephone | 616-635-1720
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | JANE ELIZABETH KORENSTRA METZ
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Credential | MSOTR,L
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Telephone | 616-635-1720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0003354
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License Number State | CO
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