Individual
MICHELLE RENEE PROVOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1829 DENVER WEST DR, GOLDEN, CO 80401-3120
(303) 982-7276
Mailing address
8531 W 86TH CIR, ARVADA, CO 80005-1517
(847) 477-0860
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
13-0360
NV
225X00000X
Occupational Therapist
Primary
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17185033
—
CO
Enumeration date
09/24/2013
Last updated
04/08/2024
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