Provider Demographics
NPI:1548937782
Name:MCCLOSKEY, COLLEEN DENISE (OT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:DENISE
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 SUNSHINE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9722
Mailing Address - Country:US
Mailing Address - Phone:267-980-9689
Mailing Address - Fax:
Practice Address - Street 1:6500 ARAPAHOE RD
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1407
Practice Address - Country:US
Practice Address - Phone:267-980-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014982225XP0200X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics