Provider Demographics
NPI:1750802138
Name:PELICAN HOME THERAPY
Entity type:Organization
Organization Name:PELICAN HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RANDIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:970-301-9415
Mailing Address - Street 1:822 DURUM ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-6017
Mailing Address - Country:US
Mailing Address - Phone:970-301-9415
Mailing Address - Fax:970-573-6585
Practice Address - Street 1:822 DURUM ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-6017
Practice Address - Country:US
Practice Address - Phone:970-301-9415
Practice Address - Fax:970-573-6585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0004124225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty