Healthcare Provider Details

I. General information

NPI: 1104956424
Provider Name (Legal Business Name): COLLEEN MARIE KAIPUS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS COLLEEN MARIE GORITY

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 LELARAY STREET DEVELOPMENTAL PEDIATRICS INC
COLORADO SPRINGS CO
80909
US

IV. Provider business mailing address

2210 LELARAY STREET DEVELOPMENTAL PEDIATRICS INC
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 719-475-0477
  • Fax: 719-475-1021
Mailing address:
  • Phone: 719-475-0477
  • Fax: 719-475-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1013501
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: