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General NPI Number Information
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NPI Number | 1982853073
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN MEMORY CENTER PLLC
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Dates
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Enumeration Date | 09/12/2008
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 951 LAPORTE AVE
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City | FORT COLLINS
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State | CO
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Zip | 80521-2522
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Country | US
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Telephone | 970-221-1073
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 REMINGTON ST STE 1
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City | FORT COLLINS
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State | CO
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Zip | 80525-2566
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Country | US
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Telephone | 970-221-1073
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. KATHLEEN A LAUREN
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Credential | ED.D.
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Telephone | 970-221-1073
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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 | 1024531
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1990
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License Number State | CO
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