Provider Demographics
NPI:1578447488
Name:BANKS, MICHELLE (COTA/L)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:2365 PATRIOT HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-5122
Mailing Address - Country:US
Mailing Address - Phone:719-667-5668
Mailing Address - Fax:719-667-5668
Practice Address - Street 1:2365 PATRIOT HTS
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-5122
Practice Address - Country:US
Practice Address - Phone:719-667-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0001042224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty