Provider Demographics
NPI:1053684845
Name:BACA, CINDY LYNNE (OTR)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LYNNE
Last Name:BACA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66312 US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CO
Mailing Address - Zip Code:81039-9606
Mailing Address - Country:US
Mailing Address - Phone:719-568-0040
Mailing Address - Fax:
Practice Address - Street 1:66312 US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:FOWLER
Practice Address - State:CO
Practice Address - Zip Code:81039-9606
Practice Address - Country:US
Practice Address - Phone:719-568-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1424225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist