Provider Demographics
NPI:1083124580
Name:KOSTER, JESSICA ANN (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:ANN
Last Name:KOSTER
Suffix:
Gender:F
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 1:12061 TEJON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2325
Mailing Address - Country:US
Mailing Address - Phone:303-665-6800
Mailing Address - Fax:303-265-9820
Practice Address - Street 1:12061 TEJON ST STE 300
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2325
Practice Address - Country:US
Practice Address - Phone:303-665-6800
Practice Address - Fax:303-265-9820
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008531225X00000X
COOT.0004892225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist