Provider Demographics
NPI:1235780222
Name:PAXTON, THEA (OTR/L)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:
Last Name:PAXTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:THEA
Other - Middle Name:
Other - Last Name:SCHUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8614 SILVER GLEN DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4067
Mailing Address - Country:US
Mailing Address - Phone:414-313-4777
Mailing Address - Fax:
Practice Address - Street 1:8614 SILVER GLEN DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4067
Practice Address - Country:US
Practice Address - Phone:414-313-4777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-22
Last Update Date:2019-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005800225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist