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NPI Code Detail

MEDICARE: MRS. ELOISE BERNICE GARRISON OTR

MEDICARE: MRS. ELOISE BERNICE GARRISON 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
1225X00000XOccupational Therapist580CO

General Provider Information

NPI Number : 1669701488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELOISE BERNICE GARRISON OTR
Provider Business Mailing Address
First Line : 4852 S CEDAR RD
Second Line :
City : EVERGREEN
State : CO
Zip : 80439-7355
Country : US
Telephone Number : 303-679-3595
Fax Number :
Provider Business Practice Location Address
First Line : 333 S EATON ST
Second Line :
City : LAKEWOOD
State : CO
Zip : 80226-3544
Country : US
Telephone Number : 303-937-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2009
Last Update Date : 12/08/2009

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