Provider Demographics
NPI:1124594254
Name:SODERSTROM, ZOE D (COTA/L)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:D
Last Name:SODERSTROM
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 WESTERN DR APT 1C
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915-4017
Mailing Address - Country:US
Mailing Address - Phone:708-714-0700
Mailing Address - Fax:
Practice Address - Street 1:5055 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1388
Practice Address - Country:US
Practice Address - Phone:719-568-9848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001087224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant