Healthcare Provider Details

I. General information

NPI: 1881714368
Provider Name (Legal Business Name): DEVELOPMENTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 ELM AVE
CANON CITY CO
81212-4431
US

IV. Provider business mailing address

700 S 8TH ST
CANON CITY CO
81212-4906
US

V. Phone/Fax

Practice location:
  • Phone: 719-269-2251
  • Fax: 719-269-2251
Mailing address:
  • Phone: 719-275-1616
  • Fax: 719-269-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRYANA JO MARSICANO
Title or Position: CEO
Credential:
Phone: 719-269-2213