Provider Demographics
NPI:1811093297
Name:BOTSFORD, JENNIFER A (OTR CHT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BOTSFORD
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 BELLAIRE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4937
Mailing Address - Country:US
Mailing Address - Phone:303-316-0164
Mailing Address - Fax:
Practice Address - Street 1:1721 E 19TH AVE
Practice Address - Street 2:STE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1242
Practice Address - Country:US
Practice Address - Phone:303-830-8226
Practice Address - Fax:303-860-9048
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35185848Medicaid
CO1073560001Medicare NSC
COC810574Medicare PIN