MEDICARE: SUMMIT OCCUPATIONAL 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

General Provider Information

NPI Number	:	1619766441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUMMIT OCCUPATIONAL THERAPY LLC

Provider Business Mailing Address
First Line	:	1730 S COLLEGE AVE STE 301
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 S COLLEGE AVE STE 301
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1073
Country	:	US
Telephone Number	:	970-900-6930
Fax Number	:	970-449-0576

Authorized Official
Title or Position	:	CO-OWNER
Name	:	JESSICA HOGAN
Credential	:	M.S. CCC-SLP
Telephone Number	:	617-448-5633

Provider Enumeration Date	:	05/06/2025
Last Update Date	:	05/06/2025

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