Healthcare Provider Details

I. General information

NPI: 1033764790
Provider Name (Legal Business Name): TORI COLLIGNON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TUTOR LN STE 107
EVANSVILLE IN
47715-7295
US

IV. Provider business mailing address

900 TUTOR LN STE 107
EVANSVILLE IN
47715-7295
US

V. Phone/Fax

Practice location:
  • Phone: 812-602-1038
  • Fax: 812-602-1048
Mailing address:
  • Phone: 812-602-1038
  • Fax: 812-602-1048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-57478
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: