Provider Demographics
NPI:1972545564
Name:FLETCHER, BETH (OT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 CHELAN ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-4866
Mailing Address - Country:US
Mailing Address - Phone:303-273-9729
Mailing Address - Fax:
Practice Address - Street 1:8550 W 38TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4300
Practice Address - Country:US
Practice Address - Phone:303-421-1440
Practice Address - Fax:303-421-2524
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA489872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO33038830Medicaid
COC806699Medicare PIN
CO33038830Medicaid