Provider Demographics
NPI:1437344629
Name:SPECIALIZED REHABILITATION, INC.
Entity Type:Organization
Organization Name:SPECIALIZED REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:TEBON
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:303-904-8133
Mailing Address - Street 1:9200 W CROSS DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-2239
Mailing Address - Country:US
Mailing Address - Phone:303-904-8133
Mailing Address - Fax:303-904-8109
Practice Address - Street 1:9200 W CROSS DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2239
Practice Address - Country:US
Practice Address - Phone:303-904-8133
Practice Address - Fax:303-904-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
003122225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC512008Medicare PIN