Healthcare Provider Details

I. General information

NPI: 1356552673
Provider Name (Legal Business Name): CATHERINE VIRGINIA DARDIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLETON AVE
BOULDER CO
80304-3979
US

IV. Provider business mailing address

1605 QUINCE AVE
BOULDER CO
80304-1110
US

V. Phone/Fax

Practice location:
  • Phone: 303-441-0450
  • Fax: 303-441-2215
Mailing address:
  • Phone: 303-447-2624
  • Fax: 303-441-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: