Provider Demographics
NPI:1174742068
Name:CYNTHIA SHIKO OTR,CMT,LLC
Entity type:Organization
Organization Name:CYNTHIA SHIKO OTR,CMT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHIKO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,CMT
Authorized Official - Phone:720-205-8130
Mailing Address - Street 1:2472 N FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1217
Mailing Address - Country:US
Mailing Address - Phone:720-205-8130
Mailing Address - Fax:720-304-3523
Practice Address - Street 1:75 MANHATTAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4254
Practice Address - Country:US
Practice Address - Phone:720-205-8130
Practice Address - Fax:720-304-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO66032270Medicaid