Provider Demographics
NPI:1447597711
Name:MAXEY, ADRIENNE A (OT)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:A
Last Name:MAXEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 SADDLEMOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2112
Mailing Address - Country:US
Mailing Address - Phone:888-701-9216
Mailing Address - Fax:866-569-1087
Practice Address - Street 1:92 SADDLEMOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2112
Practice Address - Country:US
Practice Address - Phone:888-701-9216
Practice Address - Fax:866-569-1087
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1850225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65801741Medicaid