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General NPI Number Information
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NPI Number | 1083674394
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Entity Type | Individual
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Provider Name | TINA S COLLOP OTR/L
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 7915 HARBOR MASTER CT
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City | DENVER
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State | NC
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Zip | 28037-8782
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Country | US
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Telephone | 704-483-8153
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Fax |
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Provider Business Mailing Address
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Address Line | 19215 PENINSULA SHORES DR
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City | CORNELIUS
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State | NC
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Zip | 28031-7579
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Country | US
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Telephone | 704-895-7343
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Fax | 704-237-3463
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0889
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License Number State | NC
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