Healthcare Provider Details

I. General information

NPI: 1003079096
Provider Name (Legal Business Name): KATHLEEN ANNE STUMPF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 10/31/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 ARAPAHOE RD
BOULDER CO
80303-1407
US

IV. Provider business mailing address

6500 ARAPAHOE RD
BOULDER CO
80303-1407
US

V. Phone/Fax

Practice location:
  • Phone: 303-447-1010
  • Fax:
Mailing address:
  • Phone: 262-719-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT0003421
License Number StateCO

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: