Healthcare Provider Details

I. General information

NPI: 1740138288
Provider Name (Legal Business Name): KIMBERLY CROUCH-WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E CHERRY CREEK SOUTH DR STE 710
DENVER CO
80246-1534
US

IV. Provider business mailing address

9563 W CROSS PL
LITTLETON CO
80123-2316
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-8487
  • Fax: 855-937-5828
Mailing address:
  • Phone: 303-921-8374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA.0001941
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: