Healthcare Provider Details

I. General information

NPI: 1114408051
Provider Name (Legal Business Name): CASSIE MARIE GRAZIANO MOT, LOTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 MARK DABLING BLVD STE 190
COLORADO SPRINGS CO
80919-2248
US

IV. Provider business mailing address

5725 MARK DABLING BLVD STE 190
COLORADO SPRINGS CO
80919-2248
US

V. Phone/Fax

Practice location:
  • Phone: 719-389-1118
  • Fax: 719-389-1191
Mailing address:
  • Phone: 719-389-1118
  • Fax: 719-389-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0009284
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: