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General NPI Number Information
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NPI Number | 1770722621
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Entity Type | Organization
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Legal Business Name | JUMP UP O.T. LLC
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 1931 BOISE AVE
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City | LOVELAND
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State | CO
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Zip | 80538-4295
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Country | US
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Telephone | 970-412-1563
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Fax |
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Provider Business Mailing Address
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Address Line | 3162 SILVER LEAF DR
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City | LOVELAND
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State | CO
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Zip | 80538-2852
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Country | US
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Telephone | 970-412-1563
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN CALDWELL MCCRACKEN
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Credential | OTR
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Telephone | 970-412-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 1909
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License Number State | CO
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