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General NPI Number Information
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NPI Number | 1518233139
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Entity Type | Individual
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Provider Name | PATRICIA FANTAUZZO OTA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2012
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 4686 E ASBURY CIR
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City | DENVER
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State | CO
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Zip | 80222-4723
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Country | US
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Telephone | 303-756-1566
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Fax |
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Provider Business Mailing Address
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Address Line | 1454 STERLING HILL CT
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City | CASTLE ROCK
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State | CO
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Zip | 80104-7605
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Country | US
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Telephone | 303-818-9276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 999337
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License Number State |
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