=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386448884
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FERNANDO CARLOS COLON OTR/L
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 TOWN BANK RD
-----------------------------------------------------
City | NORTH CAPE MAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08204-4411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-898-8899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 ROYAL AVE
-----------------------------------------------------
City | EGG HARBOR TWP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08234-7323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-576-9774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 46TR00772400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------