Provider Demographics
NPI:1366948945
Name:FOWLER, KRISTIN OLIVER (COTA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:OLIVER
Last Name:FOWLER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:RITA
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7835 GREENBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-4130
Mailing Address - Country:US
Mailing Address - Phone:704-726-0739
Mailing Address - Fax:
Practice Address - Street 1:2121 MESA DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3621
Practice Address - Country:US
Practice Address - Phone:704-726-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001036224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant