Healthcare Provider Details

I. General information

NPI: 1366730319
Provider Name (Legal Business Name): MRS. TRICIA LOUISE CAUTHON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1996 COLT CT
ELIZABETH CO
80107-8472
US

IV. Provider business mailing address

1996 COLT CT
ELIZABETH CO
80107-8472
US

V. Phone/Fax

Practice location:
  • Phone: 303-646-3726
  • Fax:
Mailing address:
  • Phone: 303-646-3726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1008056
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: