Provider Demographics
NPI:1215088851
Name:RICHARDSON, KIRBY K (OTR)
Entity type:Individual
Prefix:MRS
First Name:KIRBY
Middle Name:K
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:K
Other - Last Name:BOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2472 PATTERSON RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1100
Mailing Address - Country:US
Mailing Address - Phone:970-245-0511
Mailing Address - Fax:970-245-1025
Practice Address - Street 1:2472 PATTERSON RD UNIT 9
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1100
Practice Address - Country:US
Practice Address - Phone:970-245-0511
Practice Address - Fax:970-245-1025
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1015694174400000X
COOT.0002679225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO453098Medicare ID - Type Unspecified