Provider Demographics
NPI:1164785663
Name:VISION FOR LIVING OCCUPATIONAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:VISION FOR LIVING OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/OTR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, SCLV
Authorized Official - Phone:719-641-5993
Mailing Address - Street 1:5819 ADAMANTS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2021
Mailing Address - Country:US
Mailing Address - Phone:719-641-5993
Mailing Address - Fax:
Practice Address - Street 1:5819 ADAMANTS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2021
Practice Address - Country:US
Practice Address - Phone:719-641-5993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3055225XL0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XL0004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistLow VisionGroup - Single Specialty