Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0002215 | CO |
NPI | 1245684810 |
---|---|
Provider Name | Amy Kieffer |
First Address | Thornton, CO 80233-2800 |
Second Address | Broomfield, CO 80020-1477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2016 |
Last Update Date | 20/04/2016 |