Healthcare Provider Details

I. General information

NPI: 1003142878
Provider Name (Legal Business Name): KELLI BIEL-KAUTZ OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 THRUSH GRV
COLORADO SPRINGS CO
80920-5909
US

IV. Provider business mailing address

2656 THRUSH GRV
COLORADO SPRINGS CO
80920-5909
US

V. Phone/Fax

Practice location:
  • Phone: 719-265-2515
  • Fax: 866-586-4505
Mailing address:
  • Phone: 719-265-2515
  • Fax: 866-586-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number978949
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number978949
License Number StateCO

VIII. Authorized Official

Name: KELLIE BIEL-KAUTZ
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR
Phone: 719-265-2515