Healthcare Provider Details

I. General information

NPI: 1568715902
Provider Name (Legal Business Name): BETH FISHMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7180 E ORCHARD RD SUITE 103
CENTENNIAL CO
80111-1724
US

IV. Provider business mailing address

7180 E ORCHARD RD SUITE 103
CENTENNIAL CO
80111-1724
US

V. Phone/Fax

Practice location:
  • Phone: 303-850-9499
  • Fax: 303-850-7032
Mailing address:
  • Phone: 303-850-9499
  • Fax: 303-850-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1197
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: