MEDICARE: ON THE SUMMIT 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	OT.0004830	CO

General Provider Information

NPI Number	:	1588165930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE SUMMIT THERAPY LLC

Provider Business Mailing Address
First Line	:	1110 1/2 PETERSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3727
Country	:	US
Telephone Number	:	904-651-4435
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 1/2 PETERSON ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3727
Country	:	US
Telephone Number	:	904-651-4435
Fax Number	:

Authorized Official
Title or Position	:	SOLE MBR
Name	:	DAVID COLANGELO
Credential	:	OTR
Telephone Number	:	904-651-4435

Provider Enumeration Date	:	02/21/2018
Last Update Date	:	02/21/2018

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Directions to “ON THE SUMMIT THERAPY LLC ” Practice Location

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