Provider Demographics
NPI:1063833259
Name:PEEK-A-BOO PEDIATRIC THERAPY LLC
Entity Type:Organization
Organization Name:PEEK-A-BOO PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SHIMKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, OTR/L
Authorized Official - Phone:303-885-9848
Mailing Address - Street 1:172 S LOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1934
Mailing Address - Country:US
Mailing Address - Phone:303-885-9848
Mailing Address - Fax:720-302-0459
Practice Address - Street 1:172 S LOWELL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-1934
Practice Address - Country:US
Practice Address - Phone:303-885-9848
Practice Address - Fax:720-302-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT0003580252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03133729Medicaid