Healthcare Provider Details

I. General information

NPI: 1659527349
Provider Name (Legal Business Name): ANNE ASTRELLA BUEL COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 GUNSTOCK DR
COLORADO SPRINGS CO
80921-3624
US

IV. Provider business mailing address

12205 GUNSTOCK DR
COLORADO SPRINGS CO
80921-3624
US

V. Phone/Fax

Practice location:
  • Phone: 719-481-8699
  • Fax: 719-481-8515
Mailing address:
  • Phone: 719-481-8699
  • Fax: 719-481-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1009212 NBCOTA
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: