Provider Demographics
NPI:1629800610
Name:HYNEK, MARIE ELIZABETH (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ELIZABETH
Last Name:HYNEK
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1246
Mailing Address - Country:US
Mailing Address - Phone:303-919-1927
Mailing Address - Fax:
Practice Address - Street 1:17230 JACKSON CREEK PKWY STE 220
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-7304
Practice Address - Country:US
Practice Address - Phone:719-488-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist