Provider Demographics
NPI:1154618213
Name:KYBURZ, EMILY JO (MS, OTR)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JO
Last Name:KYBURZ
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JO
Other - Last Name:CLADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2307 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4614
Mailing Address - Country:US
Mailing Address - Phone:970-275-2960
Mailing Address - Fax:
Practice Address - Street 1:2307 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4614
Practice Address - Country:US
Practice Address - Phone:970-275-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3225225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist