Provider Demographics
NPI:1851536783
Name:WAGNER, ALETA D (OTR/L)
Entity type:Individual
Prefix:
First Name:ALETA
Middle Name:D
Last Name:WAGNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:ALETA
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:251 FRONT ST STE 10
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9137
Mailing Address - Country:US
Mailing Address - Phone:719-481-3121
Mailing Address - Fax:719-481-3121
Practice Address - Street 1:251 FRONT ST STE 10
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9137
Practice Address - Country:US
Practice Address - Phone:719-481-3121
Practice Address - Fax:719-481-3121
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2025-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist