Provider Demographics
NPI:1265850960
Name:PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:PEDIATRIC OCCUPATIONAL THERAPY SERVICES, LLC
Other - Org Name:LITTLE BUGS GYM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:970-215-9693
Mailing Address - Street 1:2125 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1638
Mailing Address - Country:US
Mailing Address - Phone:970-493-1115
Mailing Address - Fax:
Practice Address - Street 1:1125 W DRAKE RD STE B8
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6031
Practice Address - Country:US
Practice Address - Phone:970-215-9693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0001390225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty