Provider Demographics
NPI:1083370407
Name:MOVEMENT OPTIMIZATION THERAPY LLC
Entity Type:Organization
Organization Name:MOVEMENT OPTIMIZATION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:970-690-6696
Mailing Address - Street 1:37160 DICKERSON RUN
Mailing Address - Street 2:
Mailing Address - City:SEVERANCE
Mailing Address - State:CO
Mailing Address - Zip Code:80550-8403
Mailing Address - Country:US
Mailing Address - Phone:970-690-6696
Mailing Address - Fax:970-449-0525
Practice Address - Street 1:37160 DICKERSON RUN
Practice Address - Street 2:
Practice Address - City:SEVERANCE
Practice Address - State:CO
Practice Address - Zip Code:80550-8403
Practice Address - Country:US
Practice Address - Phone:970-690-6696
Practice Address - Fax:970-449-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center