Provider Demographics
NPI:1730104563
Name:SEIBERT, KATHRYN H (OTR)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:H
Last Name:SEIBERT
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 1:2955 PROFESSIONAL PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8139
Mailing Address - Country:US
Mailing Address - Phone:719-227-7079
Mailing Address - Fax:719-227-7061
Practice Address - Street 1:2233 ACADEMY PL
Practice Address - Street 2:SUITE 50
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1696
Practice Address - Country:US
Practice Address - Phone:719-475-0808
Practice Address - Fax:719-475-8822
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT 977316225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO301988Medicare PIN