Provider Demographics
NPI:1053385799
Name:RHODES, KEVIN MATTHEW (OTR, CHT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:RHODES
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 29TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2797
Mailing Address - Country:US
Mailing Address - Phone:970-663-6142
Mailing Address - Fax:970-635-3087
Practice Address - Street 1:107 W 29TH ST
Practice Address - Street 2:STE 100
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2797
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-635-3087
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO634225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805619Medicare PIN
CO82584079Medicaid