Provider Demographics
NPI:1376171926
Name:COLLABORATIVE CARE OT
Entity Type:Organization
Organization Name:COLLABORATIVE CARE OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:714-274-3463
Mailing Address - Street 1:2955 W STUART ST APT 5
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6619
Mailing Address - Country:US
Mailing Address - Phone:714-274-4643
Mailing Address - Fax:
Practice Address - Street 1:2955 W STUART ST APT 5
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6619
Practice Address - Country:US
Practice Address - Phone:714-274-3463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-30
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty