Healthcare Provider Details

I. General information

NPI: 1942463211
Provider Name (Legal Business Name): CHRISTIAN ROBIN SHORT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1685 S 21ST ST
COLORADO SPRINGS CO
80904-5123
US

IV. Provider business mailing address

113 QUINCY ST
PUEBLO CO
81004-4217
US

V. Phone/Fax

Practice location:
  • Phone: 719-329-1774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: