Provider Demographics
NPI:1629234174
Name:AGOMOH, SYLVERLINE ANURIKA
Entity Type:Individual
Prefix:
First Name:SYLVERLINE
Middle Name:ANURIKA
Last Name:AGOMOH
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 1:25031 E 2ND PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-4568
Mailing Address - Country:US
Mailing Address - Phone:720-318-1993
Mailing Address - Fax:
Practice Address - Street 1:2115 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8007
Practice Address - Country:US
Practice Address - Phone:970-254-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health