Provider Demographics
NPI:1477062586
Name:RUSHFORD, NICOLE CHERIE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHERIE
Last Name:RUSHFORD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:CHERIE
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14300 WATERSIDE LN UNIT B1
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4541
Mailing Address - Country:US
Mailing Address - Phone:951-326-4516
Mailing Address - Fax:
Practice Address - Street 1:1700 WHEELING ST BLDG G1
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7211
Practice Address - Country:US
Practice Address - Phone:303-399-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0005082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO225X00000XMedicaid