MEDICARE: DEANN MAE HUNT OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XH1200X	Hand Occupational Therapist	OT.0005363	CO
2	225XP0200X	Pediatric Occupational Therapist	OT.0005363	CO
3	225X00000X	Occupational Therapist	OT.0005363	CO

General Provider Information

NPI Number	:	1053898049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANN MAE HUNT OTR/L

Provider Business Mailing Address
First Line	:	2248 SILVER OAKS DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6428
Country	:	US
Telephone Number	:	970-226-6522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2248 SILVER OAKS DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6428
Country	:	US
Telephone Number	:	970-226-6522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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