Provider Demographics
NPI:1407870397
Name:CLARK, CYNTHIA (MS OTR BCP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MS OTR BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BRYANT ST STE 340
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4154
Mailing Address - Country:US
Mailing Address - Phone:303-433-0852
Mailing Address - Fax:303-477-9223
Practice Address - Street 1:2727 BRYANT ST STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-4154
Practice Address - Country:US
Practice Address - Phone:303-433-0852
Practice Address - Fax:303-477-9223
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA420711225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89957229Medicaid
CO11622725Medicaid