Healthcare Provider Details

I. General information

NPI: 1467665059
Provider Name (Legal Business Name): AMANDA KUTE OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PANTHER WAY
WOODLAND PARK CO
80863-3165
US

IV. Provider business mailing address

155 PANTHER WAY
WOODLAND PARK CO
80863-3165
US

V. Phone/Fax

Practice location:
  • Phone: 719-452-1618
  • Fax:
Mailing address:
  • Phone: 719-452-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number2588
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0119003764
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0002588
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: