Provider Demographics
NPI:1558898486
Name:REBHOLZ, KELLY ANN (MOTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:REBHOLZ
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 S ROBB WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2552
Mailing Address - Country:US
Mailing Address - Phone:540-538-3440
Mailing Address - Fax:
Practice Address - Street 1:2850 COLUMBINE RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-7600
Practice Address - Country:US
Practice Address - Phone:303-433-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119007204225X00000X
COOT.0008317225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist