Provider Demographics
NPI:1295063642
Name:PHELPS, HILLARY ANNE (COTA)
Entity type:Individual
Prefix:MS
First Name:HILLARY
Middle Name:ANNE
Last Name:PHELPS
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 1:201 LAMKIN ST UNIT 101B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3476
Mailing Address - Country:US
Mailing Address - Phone:719-253-7727
Mailing Address - Fax:719-253-7729
Practice Address - Street 1:201 LAMKIN ST UNIT 101B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3476
Practice Address - Country:US
Practice Address - Phone:719-253-7727
Practice Address - Fax:719-253-7729
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO085818224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant