Healthcare Provider Details

I. General information

NPI: 1316630767
Provider Name (Legal Business Name): ALECIA RUDISILL OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 CENTENNIAL BLVD
COLORADO SPRINGS CO
80907-4094
US

IV. Provider business mailing address

1820 SCHOLAR PT APT 713
COLORADO SPRINGS CO
80905-8333
US

V. Phone/Fax

Practice location:
  • Phone: 719-327-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-008738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: