Healthcare Provider Details

I. General information

NPI: 1003035486
Provider Name (Legal Business Name): TRACI ANGELIA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 TENDERFOOT HILL RD
COLORADO SPRINGS CO
80906-3920
US

IV. Provider business mailing address

945 TENDERFOOT HILL RD
COLORADO SPRINGS CO
80906-3920
US

V. Phone/Fax

Practice location:
  • Phone: 303-587-2241
  • Fax:
Mailing address:
  • Phone: 303-587-2241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: