MEDICARE: PIKES PEAK OCCUPATIONAL 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	252Y00000X	Early Intervention Provider Agency
2	225XP0200X	Pediatric Occupational Therapist	996830	CO
3	225XP0200X	Pediatric Occupational Therapist	OT-1850	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	996830	OTHER	CO	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972776565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK OCCUPATIONAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	7100 ROSS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3311
Country	:	US
Telephone Number	:	719-339-7673
Fax Number	:	719-265-3029

Provider Business Practice Location Address
First Line	:	7100 ROSS DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3311
Country	:	US
Telephone Number	:	719-339-7673
Fax Number	:	719-265-3029

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	ADRIENNE ANN MAXEY
Credential	:	OTR/L
Telephone Number	:	719-339-7673

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	03/26/2014

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Directions to “PIKES PEAK OCCUPATIONAL THERAPY, INC. ” Practice Location

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