Healthcare Provider Details

I. General information

NPI: 1386181741
Provider Name (Legal Business Name): LINA OCHOA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
COLORADO SPRINGS CO
80913-4613
US

IV. Provider business mailing address

7814D LIGHT FIGHTER DRIVE
COLORADO SPRINGS CO
80902
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 305-979-6170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: