Provider Demographics
NPI:1376116632
Name:PHILLIPS, TRISTYN SHAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:TRISTYN
Middle Name:SHAY
Last Name:PHILLIPS
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 1:5807 E 122ND DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9622
Mailing Address - Country:US
Mailing Address - Phone:307-251-3349
Mailing Address - Fax:
Practice Address - Street 1:5807 E 122ND DR
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9622
Practice Address - Country:US
Practice Address - Phone:307-251-3349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO456025224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant