Provider Demographics
NPI:1992036941
Name:TODD, CAROLYN KAY
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:KAY
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15446 E ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3005
Mailing Address - Country:US
Mailing Address - Phone:720-529-3500
Mailing Address - Fax:720-870-9146
Practice Address - Street 1:15446 E ORCHARD RD
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80016-3005
Practice Address - Country:US
Practice Address - Phone:720-529-3500
Practice Address - Fax:720-870-9146
Is Sole Proprietor?:No
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2224225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist