Provider Demographics
NPI:1639922966
Name:REPOLA, DEVONA PAULINE (COTA/L)
Entity Type:Individual
Prefix:
First Name:DEVONA
Middle Name:PAULINE
Last Name:REPOLA
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 1:529 STARLITE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2638
Mailing Address - Country:US
Mailing Address - Phone:719-821-3772
Mailing Address - Fax:
Practice Address - Street 1:23701 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-2000
Practice Address - Country:US
Practice Address - Phone:719-543-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0000484224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant