Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.0004839 | CO |
NPI | 1003350901 |
---|---|
Provider Name | Troy Ridgeway |
First Address | Windsor, CO 80550-5915 |
Second Address | Lafayette, CO 80026-3482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2016 |
Last Update Date | 12/12/2016 |