MEDICARE: JUST FOR KIDS PEDIATRIC OCCUPATIONAL THERAPY

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	225XP0200X	Pediatric Occupational Therapist	831	CO

General Provider Information

NPI Number	:	1609019025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUST FOR KIDS PEDIATRIC OCCUPATIONAL THERAPY

Provider Business Mailing Address
First Line	:	2740 FILLMORE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4717
Country	:	US
Telephone Number	:	208-870-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 FILLMORE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-4717
Country	:	US
Telephone Number	:	208-870-9811
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	STACIE ANN LEWIS
Credential	:	OTR
Telephone Number	:	208-870-9811

Provider Enumeration Date	:	04/15/2009
Last Update Date	:	04/15/2009

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