Provider Demographics
NPI:1407310030
Name:COLBERT, ANDREA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:COLBERT
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 1:3655 EL MORRO RD LOT 159
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1326
Mailing Address - Country:US
Mailing Address - Phone:719-310-9189
Mailing Address - Fax:
Practice Address - Street 1:3655 EL MORRO RD LOT 159
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1326
Practice Address - Country:US
Practice Address - Phone:719-310-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001158224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant