Individual
TY CITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
395 S PRATT PKWY, LONGMONT, CO 80501-6436
(303) 776-6200
Mailing address
395 S PRATT PKWY, LONGMONT, CO 80501-6499
(303) 776-6200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1033890
CO
225X00000X
Occupational Therapist
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
1033890
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033890
NATIONAL CERTIFICATION
—
01
—
186900100
US DEPT. OF LABOR
CO
01
—
4915543
CIGNA PIN#
CO
Enumeration date
01/10/2007
Last updated
04/04/2024
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