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General NPI Number Information
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NPI Number | 1164193892
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Entity Type | Individual
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Provider Name | SIERRA MAXWELL
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Gender | Female
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Dates
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Enumeration Date | 09/22/2021
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 5446 N ACADEMY BLVD STE 204
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3669
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Country | US
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Telephone | 719-598-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 3720 THUNDERCLOUD DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-4971
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT.0006999
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License Number State | CO
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