Provider Demographics
NPI:1740480789
Name:MILLS, WESLEY ANDREW (OTR)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:ANDREW
Last Name:MILLS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 22ND ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-7041
Mailing Address - Country:US
Mailing Address - Phone:970-352-6082
Mailing Address - Fax:
Practice Address - Street 1:708 22ND ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-7041
Practice Address - Country:US
Practice Address - Phone:970-352-6082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1022925225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist