MEDICARE: TERRIE LEE COLE O.T.R

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	225X00000X	Occupational Therapist	OT-614	WY

General Provider Information

NPI Number	:	1063605517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRIE LEE COLE O.T.R

Provider Business Mailing Address
First Line	:	716 W MYRTLE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3636
Country	:	US
Telephone Number	:	970-218-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 W MYRTLE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-3636
Country	:	US
Telephone Number	:	970-218-0820
Fax Number	:

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

Provider Enumeration Date	:	08/18/2007
Last Update Date	:	08/18/2007

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