Healthcare Provider Details

I. General information

NPI: 1376469478
Provider Name (Legal Business Name): CAROLYN WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 E BRONCOS PKWY UNIT 100
CENTENNIAL CO
80112-7111
US

IV. Provider business mailing address

15530 E BRONCOS PKWY UNIT 100
CENTENNIAL CO
80112-7111
US

V. Phone/Fax

Practice location:
  • Phone: 720-989-0179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0009369
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: