Healthcare Provider Details

I. General information

NPI: 1235962564
Provider Name (Legal Business Name): KAITLYN MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 HARLAN ST STE 200
DENVER CO
80212-7417
US

IV. Provider business mailing address

4704 HARLAN ST STE 200
DENVER CO
80212-7417
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-0852
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number484400
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: