Provider Demographics
NPI:1104956424
Name:KAIPUS, COLLEEN MARIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MARIE
Last Name:KAIPUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MARIE
Other - Last Name:GORITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2210 LELARAY STREET
Mailing Address - Street 2:DEVELOPMENTAL PEDIATRICS INC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-475-0477
Mailing Address - Fax:719-475-1021
Practice Address - Street 1:2210 LELARAY STREET
Practice Address - Street 2:DEVELOPMENTAL PEDIATRICS INC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-475-0477
Practice Address - Fax:719-475-1021
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1013501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11476265Medicaid