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General NPI Number Information
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NPI Number | 1790284768
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL WELLNESS, LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 02/06/2018
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Provider Practice Location Address
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Address Line | 305 W MAGNOLIA ST PMB 321
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City | FORT COLLINS
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State | CO
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Zip | 80521-2804
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Country | US
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Telephone | 314-488-4288
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Fax |
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Provider Business Mailing Address
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Address Line | 305 W MAGNOLIA ST PMB 321
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City | FORT COLLINS
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State | CO
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Zip | 80521-2804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ABIGAIL NEWBY
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Credential | OTR/L
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Telephone | 314-488-4288
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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 | OT.0005264
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License Number State | CO
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