Provider Demographics
NPI:1073057113
Name:CABRERA, JOHNA (OTR)
Entity Type:Individual
Prefix:
First Name:JOHNA
Middle Name:
Last Name:CABRERA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 FALLGOLD DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5693
Mailing Address - Country:US
Mailing Address - Phone:970-218-2378
Mailing Address - Fax:
Practice Address - Street 1:5206 FALLGOLD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5693
Practice Address - Country:US
Practice Address - Phone:970-218-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist