MEDICARE: MR. STEPHEN LLOYD BRLANSKY OT

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	1007583 NBOCT	CO

General Provider Information

NPI Number	:	1295887255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN LLOYD BRLANSKY OT

Provider Business Mailing Address
First Line	:	409 E JEFFERSON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7022
Country	:	US
Telephone Number	:	719-271-7662
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 E JEFFERSON ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-7022
Country	:	US
Telephone Number	:	719-271-7662
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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