Provider Demographics
NPI:1386022515
Name:AKINAHEW, SERENA
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:AKINAHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18224 E LAYTON PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3264
Mailing Address - Country:US
Mailing Address - Phone:720-256-8875
Mailing Address - Fax:
Practice Address - Street 1:18224 E LAYTON PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-3264
Practice Address - Country:US
Practice Address - Phone:720-256-8875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO142359222Q00000X
COMT.0006105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist