Healthcare Provider Details

I. General information

NPI: 1093622458
Provider Name (Legal Business Name): ROOTED GROWTH PEDIATRIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 BERTHOUD WAY
GOLDEN CO
80401-4813
US

IV. Provider business mailing address

253 BERTHOUD WAY
GOLDEN CO
80401-4813
US

V. Phone/Fax

Practice location:
  • Phone: 303-503-8504
  • Fax:
Mailing address:
  • Phone: 303-503-8504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KELLIE BABCOCK
Title or Position: OCCUPATIONAL THERAPIST
Credential: OT
Phone: 303-503-8504