MEDICARE: MARIE HOLE OTR, CHT

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	1158	CO

General Provider Information

NPI Number	:	1083873814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE HOLE OTR, CHT

Provider Business Mailing Address
First Line	:	2446 RESEARCH PKWY
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1087
Country	:	US
Telephone Number	:	719-623-1050
Fax Number	:	719-623-1052

Provider Business Practice Location Address
First Line	:	2430 RESEARCH PKWY
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1093
Country	:	US
Telephone Number	:	719-623-1795
Fax Number	:	719-623-1053

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

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	11/04/2014

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