MEDICARE: TINA S COLLOP OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0889	NC

General Provider Information

NPI Number	:	1083674394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA S COLLOP OTR/L

Provider Business Mailing Address
First Line	:	19215 PENINSULA SHORES DR
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-7579
Country	:	US
Telephone Number	:	704-895-7343
Fax Number	:	704-237-3463

Provider Business Practice Location Address
First Line	:	7915 HARBOR MASTER CT
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8782
Country	:	US
Telephone Number	:	704-483-8153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/26/2013

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Directions to “ TINA S COLLOP OTR/L” Practice Location

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