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General NPI Number Information
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NPI Number | 1184440547
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Entity Type | Individual
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Provider Name | MIRANDA ROSE LIPP COTA/L
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Gender | Female
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 3131 S VAUGHN WAY STE 110
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City | AURORA
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State | CO
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Zip | 80014-3501
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Country | US
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Telephone | 303-775-5534
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 ACADEMY PL STE 200
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1666
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Country | US
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Telephone | 515-371-5185
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA.0001839
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License Number State | CO
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