Provider Demographics
NPI:1245493378
Name:KIRK, DOUGLAS VICTOR (MS, OTR)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:VICTOR
Last Name:KIRK
Suffix:
Gender:M
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2076
Mailing Address - Country:US
Mailing Address - Phone:970-484-2718
Mailing Address - Fax:
Practice Address - Street 1:1631 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2076
Practice Address - Country:US
Practice Address - Phone:970-484-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1012099225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist