Healthcare Provider Details

I. General information

NPI: 1811637622
Provider Name (Legal Business Name): MIKAELA TOLLESON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKEALA QUINIONES

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 S HOLLY CIR
CENTENNIAL CO
80112-1019
US

IV. Provider business mailing address

6851 S HOLLY CIR
CENTENNIAL CO
80112-1019
US

V. Phone/Fax

Practice location:
  • Phone: 720-542-8737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7283
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: