Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1200X | Hand | 1011100572HT | |
Y | 225X00000X | Occupational Therapist | 977756OT |
NPI | 1336170166 |
---|---|
Provider Name | Rae Ann Bontekoe |
First Address | Colorado Springs, CO 80909 |
Second Address | Colorado Springs, CO 80909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 24/04/2012 |