Healthcare Provider Details

I. General information

NPI: 1871902080
Provider Name (Legal Business Name): NATALIE MCKECHNIE, OTR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 NORWOOD AVE
BOULDER CO
80304-1330
US

IV. Provider business mailing address

2195 NORWOOD AVE
BOULDER CO
80304-1330
US

V. Phone/Fax

Practice location:
  • Phone: 802-373-6868
  • Fax:
Mailing address:
  • Phone: 802-373-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier95225862
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: NATALIE MCKECHNIE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 802-373-6868