Provider Demographics
NPI:1568750305
Name:LUTZ, KARISSA ALICIA (COTA)
Entity Type:Individual
Prefix:MS
First Name:KARISSA
Middle Name:ALICIA
Last Name:LUTZ
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 1:4686 E ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4723
Mailing Address - Country:US
Mailing Address - Phone:303-300-8865
Mailing Address - Fax:303-300-6546
Practice Address - Street 1:4686 E ASBURY CIR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4723
Practice Address - Country:US
Practice Address - Phone:303-300-8865
Practice Address - Fax:303-300-6546
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03772224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant