Provider Demographics
NPI:1780712281
Name:LLAMAS-CORNELISON, TANIA CECILIA (OTRL)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:CECILIA
Last Name:LLAMAS-CORNELISON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8007
Mailing Address - Country:US
Mailing Address - Phone:970-254-4872
Mailing Address - Fax:
Practice Address - Street 1:2115 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8007
Practice Address - Country:US
Practice Address - Phone:970-254-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM853225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58654381Medicaid