MEDICARE: AVERY LIAM RASON CTRS

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	225800000X	Recreation Therapist	84050

General Provider Information

NPI Number	:	1922938448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVERY LIAM RASON CTRS

Provider Business Mailing Address
First Line	:	110 S 18TH ST APT C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904-3869
Country	:	US
Telephone Number	:	910-512-2325
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 W BARAGA AVE
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3000
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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