Provider Demographics
NPI:1922420397
Name:STICE, SHIRLEY JO (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JO
Last Name:STICE
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 1:333 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-4231
Mailing Address - Country:US
Mailing Address - Phone:719-583-9785
Mailing Address - Fax:
Practice Address - Street 1:333 MEADE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-4231
Practice Address - Country:US
Practice Address - Phone:719-583-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant