Provider Demographics
NPI:1710285473
Name:PEDIATRIC THERAPIES LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NICKIE
Authorized Official - Middle Name:DEE ANN
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, ECSE
Authorized Official - Phone:720-530-5469
Mailing Address - Street 1:13083 TEJON CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-3789
Mailing Address - Country:US
Mailing Address - Phone:303-920-4698
Mailing Address - Fax:
Practice Address - Street 1:13083 TEJON CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3789
Practice Address - Country:US
Practice Address - Phone:303-920-4698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1025941225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty