Provider Demographics
NPI:1639701642
Name:NOCO NEURODEVELOPMENTAL TREATMENT SPECIALISTS
Entity Type:Organization
Organization Name:NOCO NEURODEVELOPMENTAL TREATMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:970-818-8768
Mailing Address - Street 1:3932 JOHN F KENNEDY PKWY UNIT 10F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3085
Mailing Address - Country:US
Mailing Address - Phone:970-818-8768
Mailing Address - Fax:
Practice Address - Street 1:3932 JOHN F KENNEDY PKWY UNIT 10F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3085
Practice Address - Country:US
Practice Address - Phone:970-818-8768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty