Provider Demographics
NPI:1801409495
Name:THIS VILLAGE DEVELOPMENTAL THERAPIES
Entity Type:Organization
Organization Name:THIS VILLAGE DEVELOPMENTAL THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, OT
Authorized Official - Prefix:
Authorized Official - First Name:RAEWYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROGER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:720-412-2414
Mailing Address - Street 1:719 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4722
Mailing Address - Country:US
Mailing Address - Phone:720-551-9820
Mailing Address - Fax:720-464-5908
Practice Address - Street 1:719 S UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4722
Practice Address - Country:US
Practice Address - Phone:720-551-9820
Practice Address - Fax:720-464-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty