Healthcare Provider Details

I. General information

NPI: 1154766111
Provider Name (Legal Business Name): MARIA AGOSTINA RICCOMBENI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2013
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 ROCK MESA PT
CASTLE ROCK CO
80108-7436
US

IV. Provider business mailing address

875 ROCK MESA PT
CASTLE ROCK CO
80108-7436
US

V. Phone/Fax

Practice location:
  • Phone: 305-300-0473
  • Fax:
Mailing address:
  • Phone: 305-300-0473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number.0006689
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: