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NPI Code Detail

MEDICARE: MRS. TANYA NICHOLE WENTWORTH OTR

MEDICARE: MRS. TANYA NICHOLE WENTWORTH OTR
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
1225XP0200XPediatric Occupational Therapist1000234MD

General Provider Information

NPI Number : 1558533208
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TANYA NICHOLE WENTWORTH OTR
Provider Business Mailing Address
First Line : 701 PRAIRIE HAWK DR
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-8001
Country : US
Telephone Number : 303-387-0100
Fax Number :
Provider Business Practice Location Address
First Line : 701 PRAIRIE HAWK DR
Second Line :
City : CASTLE ROCK
State : CO
Zip : 80109-8001
Country : US
Telephone Number : 303-387-0100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2008
Last Update Date : 08/25/2023

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