Provider Demographics
NPI:1578506606
Name:WOLF, BETH G (OTR, CHT,CEASII)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:G
Last Name:WOLF
Suffix:
Gender:F
Credentials:OTR, CHT,CEASII
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, CHT, CEASII
Mailing Address - Street 1:DEPT 557
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-0557
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4156
Practice Address - Street 1:9830 W I-70 FRONTAGE RD SOUTH
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033
Practice Address - Country:US
Practice Address - Phone:303-420-5296
Practice Address - Fax:303-467-4121
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA206722225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO95206221Medicaid
COC810518Medicare PIN