Provider Demographics
NPI:1982485041
Name:REICH, MICAH LEBOEUF (MOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:LEBOEUF
Last Name:REICH
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 CASTLEGATE DR N APT 825
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-8341
Mailing Address - Country:US
Mailing Address - Phone:512-574-1307
Mailing Address - Fax:
Practice Address - Street 1:2 OAKWOOD PARK PLZ STE 200
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1885
Practice Address - Country:US
Practice Address - Phone:720-788-7365
Practice Address - Fax:720-294-0284
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0008182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist