Healthcare Provider Details

I. General information

NPI: 1942105945
Provider Name (Legal Business Name): MARY GRACE BRANDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 KILLARNEY CT
LAPORTE CO
80535-9337
US

IV. Provider business mailing address

2525 ELIOT ST APT 205
DENVER CO
80211-4867
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-8196
  • Fax:
Mailing address:
  • Phone: 216-905-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: