Provider Demographics
NPI:1003169707
Name:TEACH, CECILY CLAIRE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:CECILY
Middle Name:CLAIRE
Last Name:TEACH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:CLAIRE
Other - Last Name:BRASSEUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:19925 RIVERGLEN LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8078
Mailing Address - Country:US
Mailing Address - Phone:619-869-5366
Mailing Address - Fax:
Practice Address - Street 1:19925 RIVERGLEN LN
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8078
Practice Address - Country:US
Practice Address - Phone:619-869-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
COOT.0003545225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist