Provider Demographics
NPI:1073126991
Name:CARR, JAMIE MICHELE (COTA/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELE
Last Name:CARR
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-1722
Mailing Address - Country:US
Mailing Address - Phone:720-341-8788
Mailing Address - Fax:
Practice Address - Street 1:12975 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1477
Practice Address - Country:US
Practice Address - Phone:303-785-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO437195224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant