Healthcare Provider Details

I. General information

NPI: 1699682609
Provider Name (Legal Business Name): KYNDRA ROSE BASHAM OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28577 BUFFALO PARK RD STE 215
EVERGREEN CO
80439-7370
US

IV. Provider business mailing address

28577 BUFFALO PARK RD STE 215
EVERGREEN CO
80439-7370
US

V. Phone/Fax

Practice location:
  • Phone: 801-440-5592
  • Fax:
Mailing address:
  • Phone: 801-440-5592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0009417
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: