Individual
MARY TEDESKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
722 S 8TH ST, CANON CITY, CO 81212-4906
(719) 345-4097
(719) 345-4098
Mailing address
722 S 8TH ST, CANON CITY, CO 81212
(719) 345-4097
(719) 345-4098
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1018023
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1018023
CERTIFIED OCCUPATIONAL THERAPY ASSISTANT
CO
Enumeration date
10/16/2012
Last updated
10/16/2012
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