=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154603843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN MARIE COLLINS OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2011
-----------------------------------------------------
Last Update Date | 04/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 SPORTSMAN ISLAND DR STE E
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29492-8524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-295-9253
-----------------------------------------------------
Fax | 888-659-8008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 SPORTSMAN ISLAND DR STE E
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29492-8524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-295-9253
-----------------------------------------------------
Fax | 888-659-8008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 003029
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 4141
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------