Provider Demographics
NPI:1003966433
Name:CITO, TY (OTR)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:CITO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S PRATT PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6499
Mailing Address - Country:US
Mailing Address - Phone:303-776-6200
Mailing Address - Fax:
Practice Address - Street 1:395 S PRATT PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6436
Practice Address - Country:US
Practice Address - Phone:303-776-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1033890225X00000X, 225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4915543OtherCIGNA PIN#
1033890OtherNATIONAL CERTIFICATION
CO186900100OtherUS DEPT. OF LABOR