Provider Demographics
NPI:1427126853
Name:COUCH, KRISTINE M (OTR)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:COUCH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6963 S OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1123
Mailing Address - Country:US
Mailing Address - Phone:303-618-5111
Mailing Address - Fax:303-694-4204
Practice Address - Street 1:770 W HAMPDEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2121
Practice Address - Country:US
Practice Address - Phone:303-618-5111
Practice Address - Fax:303-694-4204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA249300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO12579050Medicaid
COC533728Medicare ID - Type Unspecified
CO6674801OtherCIGNA
COCOC67082OtherBLUE CROSS