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 |