Individual provider Active NPI

Zoe D Soderstrom, COTA/L

  • Occupational Therapy Assistant
  • Pueblo, CO
National Provider Identifier
1124594254
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Therapy AssistantTaxonomy code 224Z00000X
License
0001087 Issued in CO
Practice address
5055 Outlook Blvd
Pueblo, CO 81008-1388
Phone
(719) 568-9848
NPI assigned
Oct 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 0001087 CO Primary

Addresses

Primary practice location

5055 Outlook Blvd
Pueblo, CO 81008-1388

Mailing address

842 Western Dr Apt 1C
Colorado Springs, CO 80915-4017
Phone (708) 714-0700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
0001087COMDOccupational Therapy Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539648000000",
    "number": "1124594254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "842 WESTERN DR APT 1C",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809154017",
            "telephone_number": "708-714-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5055 OUTLOOK BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081388",
            "telephone_number": "719-568-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SODERSTROM",
        "first_name": "ZOE",
        "middle_name": "D",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-16",
        "last_updated": "2018-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CO",
            "license": "0001087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.