Healthcare Provider Details

I. General information

NPI: 1205684933
Provider Name (Legal Business Name): JASEL MATIBAG IGNACIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 ACADEMY CIR STE 100
COLORADO SPRINGS CO
80909-1664
US

IV. Provider business mailing address

2105 ACADEMY CIR
COLORADO SPRINGS CO
80909-1663
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: