MEDICARE: MR. MATTHEW B DODSON OTD

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	0004071	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205030376	OTHER		NPI

General Provider Information

NPI Number	:	1205030376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW B DODSON OTD

Provider Business Mailing Address
First Line	:	2850 MCCLELLAND DR STE 3000I
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	409-739-2607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 MCCLELLAND DR STE 3000I
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5206
Country	:	US
Telephone Number	:	409-739-2607
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	09/23/2020

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