Provider Demographics
NPI:1841277860
Name:REMBAUM, MATTHEW ALAN (OT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALAN
Last Name:REMBAUM
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 19TH AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1251
Mailing Address - Country:US
Mailing Address - Phone:303-830-8226
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:80218-1251
Practice Address - Country:US
Practice Address - Phone:303-830-8226
Practice Address - Fax:303-860-9048
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67485359Medicaid
CO67485359Medicaid
COC474228Medicare PIN