Provider Demographics
NPI:1114592110
Name:OWN YOUR MOTHERHOOD
Entity Type:Organization
Organization Name:OWN YOUR MOTHERHOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:208-201-5345
Mailing Address - Street 1:2651 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4662
Mailing Address - Country:US
Mailing Address - Phone:208-201-5345
Mailing Address - Fax:
Practice Address - Street 1:2651 N YORK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4662
Practice Address - Country:US
Practice Address - Phone:208-201-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty