Provider Demographics
NPI:1376143156
Name:PATASKA, CARLIE ANN (COTA)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:ANN
Last Name:PATASKA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 W 11TH AVENUE DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6755
Mailing Address - Country:US
Mailing Address - Phone:608-393-3837
Mailing Address - Fax:
Practice Address - Street 1:5085 W 136TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-5701
Practice Address - Country:US
Practice Address - Phone:303-247-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COT-OTA.0000042224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant