Desirae Nickole Ortiz, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OTA.0001811 Issued in CO

Practice address

1301 Fortino Blvd
Pueblo, CO 81008-2032

Phone

(719) 696-7799

NPI assigned

Nov 12, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1731369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1194549592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 HOLLYWOOD DR",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810052510",
            "telephone_number": "719-470-3795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082032",
            "telephone_number": "719-696-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ORTIZ",
        "first_name": "DESIRAE",
        "middle_name": "NICKOLE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-12",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CO",
            "license": "OTA.0001811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gino Ortegon
• Joseph Ortivez
• Shyla Ortivez, RN
• Abraham Ortiz
• Andrea Ortiz
• Gerardo Ortiz, MD
• Gloriean Ortiz, LPC
• Katherine Ortiz
• Kayla Ortiz
• Sandra E Osborne, PMHNP

• Occupational Therapy Assistant in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Occupational Therapy Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.