Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 0004035 | CO |
NPI | 1164886974 |
---|---|
Provider Name | Roberta Monahan |
First Address | Pueblo, CO 81004-2252 |
Second Address | Pueblo, CO 81004-2252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2016 |
Last Update Date | 07/04/2016 |