Provider Demographics
NPI:1033568985
Name:HERONEMA, ALISA (OTR/L, OTD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:HERONEMA
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4699 KITTREDGE ST
Mailing Address - Street 2:UNIT 624
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-5752
Mailing Address - Country:US
Mailing Address - Phone:970-214-4043
Mailing Address - Fax:
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4507
Practice Address - Country:US
Practice Address - Phone:303-436-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist