Healthcare Provider Details

I. General information

NPI: 1053820134
Provider Name (Legal Business Name): KAYLA T CULBERTSON OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 S LOWELL BLVD
DENVER CO
80219-1934
US

IV. Provider business mailing address

172 S LOWELL BLVD
DENVER CO
80219-1934
US

V. Phone/Fax

Practice location:
  • Phone: 734-778-1750
  • Fax:
Mailing address:
  • Phone: 303-885-9848
  • Fax: 303-200-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0006302
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201009913
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: