Healthcare Provider Details

I. General information

NPI: 1720513732
Provider Name (Legal Business Name): SUZANNE HEPLER COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7092 HARR AVE BLDG 6492
COLORADO SPRINGS CO
80902-2190
US

IV. Provider business mailing address

7092 HARR AVE BLDG 6492
COLORADO SPRINGS CO
80902-2190
US

V. Phone/Fax

Practice location:
  • Phone: 803-645-3484
  • Fax:
Mailing address:
  • Phone: 803-645-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0131001992
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: