Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT.002610 | CO |
NPI | 1003910597 |
---|---|
Provider Name | Vanessa Grace |
First Address | Colorado Springs, CO 80924-7022 |
Second Address | Colorado Springs, CO 80924-7022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 12/08/2021 |