Healthcare Provider Details

I. General information

NPI: 1467051128
Provider Name (Legal Business Name): GROWFUL PEDIATRIC OCCUPATIONAL THERAPY LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6861 ROARING FORK TRL
BOULDER CO
80301-3630
US

IV. Provider business mailing address

6861 ROARING FORK TRL
BOULDER CO
80301-3630
US

V. Phone/Fax

Practice location:
  • Phone: 720-352-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN BROOKE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD
Phone: 720-352-2777