Provider Demographics
NPI:1255918843
Name:HEARTFULLY BOLDER OT, LLC
Entity type:Organization
Organization Name:HEARTFULLY BOLDER OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, MS, OTR/L, MS
Authorized Official - Phone:303-819-1744
Mailing Address - Street 1:637-B SOUTH BROADWAY, #142
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305
Mailing Address - Country:US
Mailing Address - Phone:303-335-0861
Mailing Address - Fax:
Practice Address - Street 1:637-B SOUTH BROADWAY, #142
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:303-335-0861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty