Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0001557 | CO |
NPI | 1033257225 |
---|---|
Provider Name | Kristen Brainard |
First Address | Highlands Ranch, CO 80129-1540 |
Second Address | Highlands Ranch, CO 80129-1540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64826333 | (05) | CO |