Provider Demographics
NPI:1417476979
Name:COX, MICHELLE DIANE (OT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:COX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 BURBANK ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1649
Mailing Address - Country:US
Mailing Address - Phone:303-358-9341
Mailing Address - Fax:303-484-3315
Practice Address - Street 1:805 BURBANK ST
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1649
Practice Address - Country:US
Practice Address - Phone:303-358-9341
Practice Address - Fax:303-484-3315
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0000979225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist