Provider Demographics
NPI:1144639873
Name:BREAK THROUGH THERAPY PLLC
Entity type:Organization
Organization Name:BREAK THROUGH THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTE
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR, BCP, HPCS
Authorized Official - Phone:757-846-6988
Mailing Address - Street 1:1349 PIKE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-1230
Mailing Address - Country:US
Mailing Address - Phone:757-846-6988
Mailing Address - Fax:
Practice Address - Street 1:1349 PIKE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1230
Practice Address - Country:US
Practice Address - Phone:757-846-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2588261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1067454OtherNBCOT
CO2588OtherOCCUPATIONAL THERAPY REGISTRATION