MEDICARE: MR. CRAIG HENRY B.O.C.O., B.O.C.PED

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	222Z00000X	Orthotist

General Provider Information

NPI Number	:	1447640396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG HENRY B.O.C.O., B.O.C.PED

Provider Business Mailing Address
First Line	:	7208 WOODROW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-8207
Country	:	US
Telephone Number	:	970-372-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	7208 WOODROW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525
Country	:	US
Telephone Number	:	970-372-1273
Fax Number	:

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

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	09/03/2018

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