Provider Demographics
NPI:1053864728
Name:BRAVEHEART, ISAIAH ARCTURUS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:ARCTURUS
Last Name:BRAVEHEART
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14261 E TUFTS PL APT 205
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1029
Mailing Address - Country:US
Mailing Address - Phone:720-916-5872
Mailing Address - Fax:
Practice Address - Street 1:22195 E LAKE AVE
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4578
Practice Address - Country:US
Practice Address - Phone:720-842-2552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
COOT.0005042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist