Provider Demographics
NPI:1548501257
Name:BREITBARTH, GARRETT MATTHEW (OTR)
Entity type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:MATTHEW
Last Name:BREITBARTH
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 DESERT WILLOW WAY UNIT B4
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7805
Mailing Address - Country:US
Mailing Address - Phone:970-290-8808
Mailing Address - Fax:
Practice Address - Street 1:11169 E I25 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-5276
Practice Address - Country:US
Practice Address - Phone:720-378-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0003632225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics