Provider Demographics
NPI:1720402555
Name:TRAVIS, PAULA MICHELE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MICHELE
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PRAIRIE HAWK DR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8001
Mailing Address - Country:US
Mailing Address - Phone:720-433-1258
Mailing Address - Fax:
Practice Address - Street 1:701 PRAIRIE HAWK DR
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8001
Practice Address - Country:US
Practice Address - Phone:720-433-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8785296-4201225X00000X
COOT0003855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist