Provider Demographics
NPI:1114362274
Name:VAN KIRK, MARIA JUNE (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:JUNE
Last Name:VAN KIRK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6479 E MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4428
Mailing Address - Country:US
Mailing Address - Phone:303-770-3755
Mailing Address - Fax:
Practice Address - Street 1:6479 E MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4428
Practice Address - Country:US
Practice Address - Phone:303-770-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1011999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant