Provider Demographics
NPI:1417393323
Name:PAGE, KARIN ELIZABETH BREMS (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:ELIZABETH BREMS
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 SUMMERPARK LN
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2024
Mailing Address - Country:US
Mailing Address - Phone:630-917-9869
Mailing Address - Fax:
Practice Address - Street 1:2314 SUMMERPARK LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2024
Practice Address - Country:US
Practice Address - Phone:630-917-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003658225X00000X
WYOTR-662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93180781Medicaid