Provider Demographics
NPI:1740434810
Name:MOCK, CHERYL DENISE (MS, OTR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:DENISE
Last Name:MOCK
Suffix:
Gender:F
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:PO BOX 460036
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-0036
Mailing Address - Country:US
Mailing Address - Phone:303-999-8819
Mailing Address - Fax:303-496-0208
Practice Address - Street 1:445 S GILPIN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2616
Practice Address - Country:US
Practice Address - Phone:303-999-8819
Practice Address - Fax:303-496-0208
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0000590225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO139821Medicaid