Provider Demographics
NPI:1639308935
Name:REAVES, KRISTEN ELISE-CLARKE (OTR)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ELISE-CLARKE
Last Name:REAVES
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 S JAMAICA CIR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-5748
Mailing Address - Country:US
Mailing Address - Phone:720-979-4973
Mailing Address - Fax:
Practice Address - Street 1:6029 S JAMAICA CIR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80111-5748
Practice Address - Country:US
Practice Address - Phone:720-979-4973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CO1229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist