Provider Demographics
NPI:1730851106
Name:MOUNTAIN HOME THERAPY
Entity type:Organization
Organization Name:MOUNTAIN HOME THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:970-294-2646
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CO
Mailing Address - Zip Code:80536-0118
Mailing Address - Country:US
Mailing Address - Phone:970-294-2646
Mailing Address - Fax:
Practice Address - Street 1:227 MOUNT ALICE CT
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CO
Practice Address - Zip Code:80536-8774
Practice Address - Country:US
Practice Address - Phone:970-294-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty