MEDICARE: MR. ADAM KOSOFSKY OTR/L

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	46TR00645900	NJ

General Provider Information

NPI Number	:	1609296755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADAM KOSOFSKY OTR/L

Provider Business Mailing Address
First Line	:	10901 W 120TH AVE STE 380
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10901 W 120TH AVE STE 380
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3431
Country	:	US
Telephone Number	:	866-302-0073
Fax Number	:

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

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	05/27/2015

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