Healthcare Provider Details

I. General information

NPI: 1699101287
Provider Name (Legal Business Name): ANDRE KEVIN ARAGON OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S EATON ST
LAKEWOOD CO
80226-3544
US

IV. Provider business mailing address

1591 GROVE ST
DENVER CO
80204-1929
US

V. Phone/Fax

Practice location:
  • Phone: 303-935-1448
  • Fax:
Mailing address:
  • Phone: 505-500-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0003778
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: