Provider Demographics
NPI:1619680873
Name:NATURE'S PATH OT
Entity Type:Organization
Organization Name:NATURE'S PATH OT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
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/L
Authorized Official - Phone:318-507-9909
Mailing Address - Street 1:13955 WOODLAKE RD
Mailing Address - Street 2:
Mailing Address - City:ELBERT
Mailing Address - State:CO
Mailing Address - Zip Code:80106-8893
Mailing Address - Country:US
Mailing Address - Phone:318-507-9909
Mailing Address - Fax:
Practice Address - Street 1:13955 WOODLAKE RD
Practice Address - Street 2:
Practice Address - City:ELBERT
Practice Address - State:CO
Practice Address - Zip Code:80106-8893
Practice Address - Country:US
Practice Address - Phone:318-507-9909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty