Basic Information
| Provider Information | |||||||||
| NPI: | 1265666127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURRERA | ||||||||
| FirstName: | SHAYE | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 WINDSOR LN LOT 56 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808172083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194607587 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2050 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708749773 | ||||||||
| FaxNumber: | 9708749755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/06/2009 | ||||||||
| LastUpdateDate: | 05/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.