MEDICARE: CHAD RYAN DESMARTEAU

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.0006606	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OT.0006606	OTHER	CO	COLORADO DORA

General Provider Information

NPI Number	:	1437755139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD RYAN DESMARTEAU

Provider Business Mailing Address
First Line	:	2616 N HIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 N HIGH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4542
Country	:	US
Telephone Number	:	925-964-3760
Fax Number	:

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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Directions to “ CHAD RYAN DESMARTEAU ” Practice Location

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