Healthcare Provider Details

I. General information

NPI: 1134474455
Provider Name (Legal Business Name): PATRICIA BOTHWELL KENYON OTR CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 TENNYSON ST
DENVER CO
80212-1723
US

IV. Provider business mailing address

3441 TENNYSON ST
DENVER CO
80212-1723
US

V. Phone/Fax

Practice location:
  • Phone: 303-941-0664
  • Fax: 303-997-4832
Mailing address:
  • Phone: 303-941-0664
  • Fax: 303-997-4832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number569
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: