Provider Demographics
NPI:1093221384
Name:THESSING, KRISTEN MICHELLE (CPO)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MICHELLE
Last Name:THESSING
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:CRANIAL
Other - Middle Name:
Other - Last Name:KIDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1624 SAND RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-9206
Mailing Address - Country:US
Mailing Address - Phone:719-684-4008
Mailing Address - Fax:
Practice Address - Street 1:406 E GRACE AVE STE B
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3127
Practice Address - Country:US
Practice Address - Phone:719-684-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO02572224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist