Provider Demographics
NPI:1831879485
Name:D'AGROSA, MARIA BERNADETTE (OTR)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:BERNADETTE
Last Name:D'AGROSA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NELSON RD APT H208
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9387
Mailing Address - Country:US
Mailing Address - Phone:970-263-8209
Mailing Address - Fax:
Practice Address - Street 1:2727 NELSON RD APT H208
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-9387
Practice Address - Country:US
Practice Address - Phone:970-263-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOT.0002125225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist