Provider Demographics
NPI:1508646555
Name:RICHTER, KYLIE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:RICHTER
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 1:3595 HAYDEN PL APT 5
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1940
Mailing Address - Country:US
Mailing Address - Phone:715-651-9285
Mailing Address - Fax:
Practice Address - Street 1:4300 W 75TH AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4601
Practice Address - Country:US
Practice Address - Phone:303-428-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0007351225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist