Healthcare Provider Details

I. General information

NPI: 1023529112
Provider Name (Legal Business Name): MELISSA DRAKE HUTCHINSON COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 PARKMOOR VILLAGE DR
COLORADO SPRINGS CO
80917-5205
US

IV. Provider business mailing address

5318 CRACKER BARREL CIR
COLORADO SPRINGS CO
80917-1804
US

V. Phone/Fax

Practice location:
  • Phone: 205-353-1224
  • Fax: 205-353-1224
Mailing address:
  • Phone: 205-353-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0000874
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: