Provider Demographics
NPI:1669728416
Name:FURR, KIMBERLY EHRLICH (OTR)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:EHRLICH
Last Name:FURR
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 CRYSTAL WAY
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3317
Mailing Address - Country:US
Mailing Address - Phone:970-270-3646
Mailing Address - Fax:
Practice Address - Street 1:950 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3451
Practice Address - Country:US
Practice Address - Phone:970-243-3702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2030225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800636Medicaid
CO2030OtherCOLORADO STATE LICENSE