Provider Demographics
NPI:1770360299
Name:DRIESEN, ANIKA BETH (OTR/L)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:BETH
Last Name:DRIESEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WILCOX ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1730
Mailing Address - Country:US
Mailing Address - Phone:118-470-1351
Mailing Address - Fax:
Practice Address - Street 1:2420 AUTUMN SAGE ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-2800
Practice Address - Country:US
Practice Address - Phone:720-433-0110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.00080000225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics