Provider Demographics
NPI:1972776565
Name:PIKES PEAK OCCUPATIONAL THERAPY, INC.
Entity type:Organization
Organization Name:PIKES PEAK OCCUPATIONAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:719-339-7673
Mailing Address - Street 1:7100 ROSS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3311
Mailing Address - Country:US
Mailing Address - Phone:719-339-7673
Mailing Address - Fax:719-265-3029
Practice Address - Street 1:7100 ROSS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3311
Practice Address - Country:US
Practice Address - Phone:719-339-7673
Practice Address - Fax:719-265-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO996830225XP0200X
COOT-1850225XP0200X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO996830OtherLICENSE
CO05509556Medicaid