Provider Demographics
NPI:1902017353
Name:WOOTEN, PATRICIA A (COTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:WOOTEN
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 1:272 PYRITE TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4286
Mailing Address - Country:US
Mailing Address - Phone:719-528-2511
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:104 LOIS LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-1320
Practice Address - Country:US
Practice Address - Phone:888-266-2426
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONONE224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant