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General NPI Number Information
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NPI Number | 1679050843
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Entity Type | Organization
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Legal Business Name | JUNIPER PEDIATRIC THERAPY
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 600 LONGS PEAK AVE APT 219
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City | LONGMONT
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State | CO
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Zip | 80501-4014
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Country | US
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Telephone | 217-493-0219
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Fax |
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Provider Business Mailing Address
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Address Line | 600 LONGS PEAK AVE APT 219
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City | LONGMONT
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State | CO
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Zip | 80501-4014
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Country | US
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Telephone | 217-493-0219
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Fax |
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Authorized Official
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Title or Position | OWNER, OCCUPATIONAL THERAPIST
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Name | SARAH COUCH
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Credential | OTR/L
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Telephone | 217-493-0219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT.0004721
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License Number State | CO
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