Provider Demographics
NPI:1932457009
Name:MALCHOFF, KEITH BRUCE JR (OTR)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:BRUCE
Last Name:MALCHOFF
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:CO
Mailing Address - Zip Code:80759-2704
Mailing Address - Country:US
Mailing Address - Phone:970-630-0978
Mailing Address - Fax:
Practice Address - Street 1:510 S ASH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-2704
Practice Address - Country:US
Practice Address - Phone:970-630-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1361225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist