Healthcare Provider Details

I. General information

NPI: 1174742068
Provider Name (Legal Business Name): CYNTHIA SHIKO OTR,CMT,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MANHATTAN DR SUITE 101
BOULDER CO
80303-4254
US

IV. Provider business mailing address

2472 N FRANKLIN AVE
LOUISVILLE CO
80027-1217
US

V. Phone/Fax

Practice location:
  • Phone: 720-205-8130
  • Fax: 720-304-3523
Mailing address:
  • Phone: 720-205-8130
  • Fax: 720-304-3523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier66032270
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: CYNTHIA L SHIKO
Title or Position: OWNER
Credential: OTR,CMT
Phone: 720-205-8130