NPIMap

Organization Active NPI

Evergreen Therapy LLC

  • Occupational Therapist
  • Fort Collins, CO
National Provider Identifier
1881039451
Registry record updated May 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3123 Issued in CO
Legal business name
EVERGREEN THERAPY LLC
Practice address
601 Griffin PL
Apt a
Fort Collins, CO 80521-1896
Phone
(303) 579-0322
NPI assigned
May 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Barry Darren Matsuo Pederson, OTRNPI 1215208855
Title
Owner
Phone
(303) 579-0322

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 3123 CO Primary

Addresses

Primary practice location

601 Griffin PL
Apt a
Fort Collins, CO 80521-1896

Mailing address

601 Griffin PL
Apt a
Fort Collins, CO 80521-1896
Phone (303) 579-0322

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1881039451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 GRIFFIN PL",
            "address_2": "APT A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805211896",
            "telephone_number": "303-579-0322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 GRIFFIN PL",
            "address_2": "APT A",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805211896",
            "telephone_number": "303-579-0322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "DARREN MATSUO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-579-0322",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "CO",
            "license": "3123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.