Individual
MS. LISA ROSE BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
409 BENEDICTA AVE, TRINIDAD, CO 81082-2004
(719) 646-9291
Mailing address
409 BENEDICTA AVE, TRINIDAD, CO 81082-2004
(719) 646-9291
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA0000191
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA.0000191
COLORADO STATE LICENSE
CO
Enumeration date
06/03/2014
Last updated
06/03/2014
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