MEDICARE: PREMIER HAND 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	225XH1200X	Hand Occupational Therapist	1071100083	CO

General Provider Information

NPI Number	:	1447493374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HAND THERAPY, LLC

Provider Business Mailing Address
First Line	:	362 THORN APPLE WAY
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-8255
Country	:	US
Telephone Number	:	303-660-7914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 S BELLAIRE ST
Second Line	:	SUITE 120
City	:	DENVER
State	:	CO
Zip	:	80222-4306
Country	:	US
Telephone Number	:	720-255-5655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. HOLLY E JOHNSTON
Credential	:	OTR, CHT
Telephone Number	:	720-255-5655

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	04/08/2009

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