Healthcare Provider Details

I. General information

NPI: 1063317295
Provider Name (Legal Business Name): SOMARA CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S MARSHALL RD UNIT 303
SUPERIOR CO
80027-1768
US

IV. Provider business mailing address

275 S MARSHALL RD UNIT 303
SUPERIOR CO
80027-1768
US

V. Phone/Fax

Practice location:
  • Phone: 646-926-2877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALEXIS KIKU NICCUM
Title or Position: OWNER
Credential: OTR/L
Phone: 765-639-8867