Individual
TY CITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
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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