Healthcare Provider Details

I. General information

NPI: 1609549351
Provider Name (Legal Business Name): KELSEY LEIGH HENDRICKSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6970 S HOLLY CIR STE 200
CENTENNIAL CO
80112-1066
US

IV. Provider business mailing address

6970 S HOLLY CIR STE 200
CENTENNIAL CO
80112-1066
US

V. Phone/Fax

Practice location:
  • Phone: 720-287-4185
  • Fax:
Mailing address:
  • Phone: 720-287-4185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0006966
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: