Healthcare Provider Details

I. General information

NPI: 1225532500
Provider Name (Legal Business Name): ERIN FAIRBAIRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 E ILIFF AVE STE C
DENVER CO
80231-5326
US

IV. Provider business mailing address

7770 E ILIFF AVE STE C
DENVER CO
80231-5326
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-8360
  • Fax: 303-333-8380
Mailing address:
  • Phone: 303-333-8360
  • Fax: 303-333-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3621
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: