Healthcare Provider Details

I. General information

NPI: 1194598425
Provider Name (Legal Business Name): BRIANNA MARIA SZOSTAK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA MARIA GRATAMA JACKSON

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 GOODMAN ST
TIMNATH CO
80547-2379
US

IV. Provider business mailing address

2075 HOPPER LN APT B211
LOVELAND CO
80538-8553
US

V. Phone/Fax

Practice location:
  • Phone: 970-305-5070
  • Fax:
Mailing address:
  • Phone: 813-728-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT.0009246
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: