Basic Information
| Provider Information | |||||||||
| NPI: | 1144733643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THERAPEUTIC WIRTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16429 HOMESTEAD CT | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801349344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472049270 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16429 HOMESTEAD CT | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801349344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472049270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2017 | ||||||||
| LastUpdateDate: | 11/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | WIRTH | ||||||||
| AuthorizedOfficialFirstName: | RODERICK | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8472049270 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MOT, OTR/L | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 0003876 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.