Healthcare Provider Details

I. General information

NPI: 1225858178
Provider Name (Legal Business Name): GRAZIANA ZITO MOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N 2ND ST APT 1R
PHILADELPHIA PA
19123-3062
US

IV. Provider business mailing address

631 N 2ND ST APT 1R
PHILADELPHIA PA
19123-3062
US

V. Phone/Fax

Practice location:
  • Phone: 909-505-5717
  • Fax:
Mailing address:
  • Phone: 909-505-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC018153
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOC018153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: