Basic Information
| Provider Information | |||||||||
| NPI: | 1518233139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FANTAUZZO | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1454 STERLING HILL CT | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801047605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038189276 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4686 E ASBURY CIR | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802224723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037561566 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2012 | ||||||||
| LastUpdateDate: | 03/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 999337 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.