Provider Demographics
NPI:1245353911
Name:PRESTIA, KELLY MICHELLE (MS ED OTR)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:PRESTIA
Suffix:
Gender:F
Credentials:MS ED OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 TABOR CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80005-5168
Mailing Address - Country:US
Mailing Address - Phone:303-403-4932
Mailing Address - Fax:
Practice Address - Street 1:6091 S OUEBEC ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4521
Practice Address - Country:US
Practice Address - Phone:303-504-9945
Practice Address - Fax:303-504-9946
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841465539OtherTAXI ID
CO649046OtherANTHEM
COC810184Medicare PIN