MEDICARE: AYANA WHEELER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0008349	CO

General Provider Information

NPI Number	:	1467166553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANA WHEELER

Provider Business Mailing Address
First Line	:	5240 PEACEFUL PL
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3301
Country	:	US
Telephone Number	:	859-490-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 EXPLORER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1033
Country	:	US
Telephone Number	:	719-332-4689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2023
Last Update Date	:	03/27/2024

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