Provider Demographics
NPI:1003348533
Name:HENDERSHOT, MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HENDERSHOT
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S WASHINGTON ST
Mailing Address - Street 2:308
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2056
Mailing Address - Country:US
Mailing Address - Phone:920-944-7999
Mailing Address - Fax:
Practice Address - Street 1:20 S WASHINGTON ST
Practice Address - Street 2:308
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2056
Practice Address - Country:US
Practice Address - Phone:920-944-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO368782224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant