Provider Demographics
NPI:1063606564
Name:BINGAMAN, KATHLEEN D (MS, OTR)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:D
Last Name:BINGAMAN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1638
Mailing Address - Country:US
Mailing Address - Phone:970-493-1115
Mailing Address - Fax:978-285-7724
Practice Address - Street 1:2125 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1638
Practice Address - Country:US
Practice Address - Phone:970-493-1115
Practice Address - Fax:978-285-7724
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59879718Medicaid