Healthcare Provider Details

I. General information

NPI: 1003791906
Provider Name (Legal Business Name): MADELEINE RUTH STEVENS OTD, OTR/L
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
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: 720-561-5120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0008692
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: