Provider Demographics
NPI:1841700804
Name:CULBERT, ANNA ROSE (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:CULBERT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:LOURENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 W DILLON RD APT F305
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-3218
Mailing Address - Country:US
Mailing Address - Phone:515-422-4445
Mailing Address - Fax:
Practice Address - Street 1:4770 BASELINE RD STE 360
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2676
Practice Address - Country:US
Practice Address - Phone:515-422-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA088776225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist