Provider Demographics
| NPI: | 1841998499 |
|---|---|
| Name: | LIFE SPAN THERAPY LLC |
| Entity type: | Organization |
| Organization Name: | LIFE SPAN THERAPY LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/THERAPIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ANGELA |
| Authorized Official - Middle Name: | MARIE |
| Authorized Official - Last Name: | HOWELL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | OTR/L |
| Authorized Official - Phone: | 303-842-3850 |
| Mailing Address - Street 1: | 90 FLORIDA MEADOWS CT |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DURANGO |
| Mailing Address - State: | CO |
| Mailing Address - Zip Code: | 81303-6772 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 303-842-3850 |
| Mailing Address - Fax: | 970-459-3143 |
| Practice Address - Street 1: | 450 S CAMINO DEL RIO |
| Practice Address - Street 2: | |
| Practice Address - City: | DURANGO |
| Practice Address - State: | CO |
| Practice Address - Zip Code: | 81301-6856 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 303-842-3850 |
| Practice Address - Fax: | 970-459-3143 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-02-22 |
| Last Update Date: | 2023-02-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Single Specialty |