Provider Demographics
NPI:1629788450
Name:TULL, EMILY BLYTHE (OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BLYTHE
Last Name:TULL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 ENDICOTT ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3225
Mailing Address - Country:US
Mailing Address - Phone:757-897-2839
Mailing Address - Fax:
Practice Address - Street 1:5285 MCWHINNEY BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8961
Practice Address - Country:US
Practice Address - Phone:970-286-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist