Healthcare Provider Details

I. General information

NPI: 1972999886
Provider Name (Legal Business Name): ANA ANTONETTI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2015
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PLAZA CT N
LAFAYETTE CO
80026-3530
US

IV. Provider business mailing address

5375 GUNBARREL CIR
LONGMONT CO
80503-8603
US

V. Phone/Fax

Practice location:
  • Phone: 720-805-8774
  • Fax:
Mailing address:
  • Phone: 847-754-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0004243
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.0004243
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: