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General NPI Number Information
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NPI Number | 1790957728
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Entity Type | Individual
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Provider Name | BRIAN COLVIN OT
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Gender | Male
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 16600 SPRAGUE ST. 365
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City | MIDDLEBURG HTS.
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State | OH
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Zip | 44130
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Country | US
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Telephone | 216-227-7700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 246
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-0246
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Country | US
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Telephone | 216-227-7700
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OT4906
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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