Provider Demographics
NPI:1164886974
Name:MONAHAN, ROBERTA (MS, OTR)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 S UNION AVE
Mailing Address - Street 2:APT B
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2252
Mailing Address - Country:US
Mailing Address - Phone:719-766-8047
Mailing Address - Fax:
Practice Address - Street 1:613 S UNION AVE
Practice Address - Street 2:APT B
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2252
Practice Address - Country:US
Practice Address - Phone:719-766-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0004035225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation