=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770123341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOLLY J SCHANTZ OT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2020
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 730 14TH ST SW STE 200
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80537-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-663-0815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6850 W US HIGHWAY 34 # 29
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80537-9400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-734-5320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT0000006447
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Occupational Therapist
-----------------------------------------------------
License Number | 8071
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------