MEDICARE: THRIVE PEDIATRIC THERAPY LLC

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

General Provider Information

NPI Number	:	1346717535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	2013 UNION DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1714
Country	:	US
Telephone Number	:	970-689-2298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 UNION DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1714
Country	:	US
Telephone Number	:	970-689-2298
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	MS. ABBY NICOLE MCDONNELL
Credential	:	MS OTR/L
Telephone Number	:	970-689-2298

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	10/26/2018

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