Provider Demographics
NPI:1346500774
Name:ANGELITOS 'LITTLE ANGELS' PEDIATRIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ANGELITOS 'LITTLE ANGELS' PEDIATRIC THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:LOMBARDI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, OTD
Authorized Official - Phone:719-304-6976
Mailing Address - Street 1:8277 WINDING PASSAGE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-8114
Mailing Address - Country:US
Mailing Address - Phone:719-304-6976
Mailing Address - Fax:
Practice Address - Street 1:8277 WINDING PASSAGE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-8114
Practice Address - Country:US
Practice Address - Phone:719-304-6976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO832302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO832OtherOT REGISTRATION