Provider Demographics
NPI:1528507662
Name:SHINE ON OCCUPATIONAL THERAPY FOR KIDS
Entity type:Organization
Organization Name:SHINE ON OCCUPATIONAL THERAPY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREW
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR/L
Authorized Official - Phone:720-979-5357
Mailing Address - Street 1:20044 W 94TH LN
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7726
Mailing Address - Country:US
Mailing Address - Phone:720-979-5357
Mailing Address - Fax:
Practice Address - Street 1:20044 W 94TH LN
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7726
Practice Address - Country:US
Practice Address - Phone:720-979-5357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-22
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001786261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities