Healthcare Provider Details

I. General information

NPI: 1265235428
Provider Name (Legal Business Name): DEVELOPMENTAL OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 ELM AVE
CANON CITY CO
81212-4431
US

IV. Provider business mailing address

PO BOX 2080
CANON CITY CO
81215-2080
US

V. Phone/Fax

Practice location:
  • Phone: 719-275-0550
  • Fax: 719-269-2251
Mailing address:
  • Phone: 719-275-1616
  • Fax: 719-269-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: MBA
Phone: 719-269-2213