Provider Demographics
NPI:1922665975
Name:AMY WELSH, INC
Entity Type:Organization
Organization Name:AMY WELSH, INC
Other - Org Name:ELEVATION PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:303-725-8785
Mailing Address - Street 1:1588 S LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2633
Mailing Address - Country:US
Mailing Address - Phone:303-725-8785
Mailing Address - Fax:
Practice Address - Street 1:1588 S LOGAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210
Practice Address - Country:US
Practice Address - Phone:303-725-8785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1912073115Medicaid