Healthcare Provider Details

I. General information

NPI: 1053833285
Provider Name (Legal Business Name): HANA ALISE ROVIN DOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PRINTERS PKWY STE 100
COLORADO SPRINGS CO
80910-6101
US

IV. Provider business mailing address

2295 WILLOW TREE GRV APT 202
COLORADO SPRINGS CO
80910-7112
US

V. Phone/Fax

Practice location:
  • Phone: 719-597-0822
  • Fax:
Mailing address:
  • Phone: 614-371-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0005081
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: