Provider Demographics
NPI:1255316436
Name:BOST, SANDRA C
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:BOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 S ALTON WAY
Mailing Address - Street 2:STE 6L
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2334
Mailing Address - Country:US
Mailing Address - Phone:303-790-4495
Mailing Address - Fax:720-488-1988
Practice Address - Street 1:2233 ACADEMY PL
Practice Address - Street 2:STE 50
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1696
Practice Address - Country:US
Practice Address - Phone:719-475-0808
Practice Address - Fax:719-475-8822
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO969609225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC493798Medicare PIN