Provider Demographics
NPI:1801191341
Name:FESSEHA, ABEBA T (COTA)
Entity Type:Individual
Prefix:MS
First Name:ABEBA
Middle Name:T
Last Name:FESSEHA
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 1:500 GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-4305
Mailing Address - Country:US
Mailing Address - Phone:303-364-9311
Mailing Address - Fax:
Practice Address - Street 1:19600 E IDAHO AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5558
Practice Address - Country:US
Practice Address - Phone:303-408-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1065763224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant