Provider Demographics
NPI:1093239188
Name:PARTAIN, CIERRA NICOLE (COTA)
Entity Type:Individual
Prefix:MISS
First Name:CIERRA
Middle Name:NICOLE
Last Name:PARTAIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:CIERRA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5965 VISTA RIDGE PT APT 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-9007
Mailing Address - Country:US
Mailing Address - Phone:505-289-7745
Mailing Address - Fax:
Practice Address - Street 1:8540 SCARBOROUGH DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7513
Practice Address - Country:US
Practice Address - Phone:719-680-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000889224Z00000X
NM3522224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant