=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053833285
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HANA ALISE ROVIN DOTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2017
-----------------------------------------------------
Last Update Date | 07/10/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 PRINTERS PKWY STE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-597-0822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2295 WILLOW TREE GRV APT 202
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80910-7112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-371-4406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 0005081
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------