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General NPI Number Information
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NPI Number | 1053864728
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Entity Type | Individual
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Provider Name | ISAIAH ARCTURUS BRAVEHEART OTR/L
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Gender | Male
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 22195 E LAKE AVE
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City | CENTENNIAL
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State | CO
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Zip | 80015-4578
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Country | US
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Telephone | 720-842-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 14261 E TUFTS PL APT 205
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City | AURORA
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State | CO
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Zip | 80015-1029
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Country | US
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Telephone | 720-916-5872
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT.0005042
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License Number State | CO
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