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General NPI Number Information
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NPI Number | 1457964520
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Entity Type | Individual
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Provider Name | COLLEEN ELISE NUNN OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 185 S. MAIN ST.
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City | ANGELS CAMP
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State | CA
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Zip | 95222-9522
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Country | US
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Telephone | 209-736-6074
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Fax |
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Provider Business Mailing Address
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Address Line | 250 MISTLETOE CT
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City | ANGELS CAMP
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State | CA
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Zip | 95222-9639
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Country | US
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Telephone | 209-743-3210
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Fax |
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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 | OT21003
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License Number State | CA
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