Provider Demographics
NPI:1336170166
Name:BONTEKOE, RAE ANN (OTR CHT)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:ANN
Last Name:BONTEKOE
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 E PALMER PARK BLVD
Mailing Address - Street 2:# 101C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-574-5234
Mailing Address - Fax:719-574-8277
Practice Address - Street 1:4020 E PALMER PARK BLVD
Practice Address - Street 2:# 101C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-574-5234
Practice Address - Fax:719-574-8277
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1011100572HT2251H1200X
977756OT225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803712Medicare ID - Type Unspecified