MEDICARE: ADVANCE THERAPY, INC.

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

General Provider Information

NPI Number	:	1962819367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE THERAPY, INC.

Provider Business Mailing Address
First Line	:	1125 W DRAKE RD
Second Line	:	UNIT B8
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-6031
Country	:	US
Telephone Number	:	970-214-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2768 NOTTINGHAM SQ
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-2589
Country	:	US
Telephone Number	:	970-223-2923
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LOUISE E BELLEAU
Credential	:	MS, OTR
Telephone Number	:	970-223-2923

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	07/17/2014

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Directions to “ADVANCE THERAPY, INC. ” Practice Location

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