Healthcare Provider Details

I. General information

NPI: 1568323574
Provider Name (Legal Business Name): DYSAUTONOMIA THERAPY SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 LEVITY HTS
COLORADO SPRINGS CO
80924-5423
US

IV. Provider business mailing address

6351 LEVITY HTS
COLORADO SPRINGS CO
80924-5423
US

V. Phone/Fax

Practice location:
  • Phone: 719-355-7551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARANDA CENTENO
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 719-355-7551