Provider Demographics
NPI:1154932333
Name:BIZZELL, CARLEE AMBER (COTA)
Entity type:Individual
Prefix:
First Name:CARLEE
Middle Name:AMBER
Last Name:BIZZELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1397 CELTIC ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1373
Mailing Address - Country:US
Mailing Address - Phone:432-208-6767
Mailing Address - Fax:
Practice Address - Street 1:1397 CELTIC ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1373
Practice Address - Country:US
Practice Address - Phone:432-208-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001335224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant