Provider Demographics
NPI:1205669082
Name:ANDERSON, DELIANA W (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:DELIANA
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 ELK RUN RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:CO
Mailing Address - Zip Code:81647-9529
Mailing Address - Country:US
Mailing Address - Phone:970-274-2457
Mailing Address - Fax:
Practice Address - Street 1:839 WHITERIVER AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3515
Practice Address - Country:US
Practice Address - Phone:970-274-2457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
COOT.0001555225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics