Provider Demographics
NPI:1477506368
Name:KELLSTROM, CARA GRADY (OTR/L)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:GRADY
Last Name:KELLSTROM
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:CARA
Other - Middle Name:THOMPSON
Other - Last Name:GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:68 S MC INTYRE WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-5083
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:303-362-0946
Practice Address - Street 1:6235 S MAIN ST STE C-101
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5373
Practice Address - Country:US
Practice Address - Phone:303-344-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1342225X00000X
WYOT-486225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89902378Medicaid
CO89902378Medicaid