Provider Demographics
NPI:1992064802
Name:TELLEZ, ANNE CHRISTINE (MS, OTR)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:CHRISTINE
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 S PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8857
Mailing Address - Country:US
Mailing Address - Phone:719-232-1407
Mailing Address - Fax:
Practice Address - Street 1:9457 S UNIVERSITY BLVD # 271
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-4976
Practice Address - Country:US
Practice Address - Phone:720-231-3964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1028872225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist