Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics | OT.0006339 | CO |
NPI | 1043845068 |
---|---|
Provider Name | Jasmine Danielle-Evans Riecken |
First Address | Colorado Springs, CO 80901-2305 |
Second Address | Colorado Springs, CO 80918-3669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |