=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093622458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROOTED GROWTH PEDIATRIC THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2026
-----------------------------------------------------
Last Update Date | 08/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 253 BERTHOUD WAY
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-4813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-503-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 BERTHOUD WAY
-----------------------------------------------------
City | GOLDEN
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80401-4813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-503-8504
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | KELLIE BABCOCK
-----------------------------------------------------
Credential | OT
-----------------------------------------------------
Telephone | 303-503-8504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------