Provider Demographics
NPI:1942849807
Name:REICHENBACH, NICOLE ALYSSA (COTA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSSA
Last Name:REICHENBACH
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 1:232 S JASPER CIR APT 104
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-2055
Mailing Address - Country:US
Mailing Address - Phone:570-428-2499
Mailing Address - Fax:
Practice Address - Street 1:232 S JASPER CIR APT 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-2055
Practice Address - Country:US
Practice Address - Phone:570-428-2499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-24
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO.0001249224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant