MEDICARE: MRS. ANN MARIE COLLINS 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	225XP0200X	Pediatric Occupational Therapist	003029	CT
2	225XP0200X	Pediatric Occupational Therapist	4141	SC

General Provider Information

NPI Number	:	1154603843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN MARIE COLLINS OTR/L

Provider Business Mailing Address
First Line	:	142 SPORTSMAN ISLAND DR STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8524
Country	:	US
Telephone Number	:	904-295-9253
Fax Number	:	888-659-8008

Provider Business Practice Location Address
First Line	:	142 SPORTSMAN ISLAND DR STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8524
Country	:	US
Telephone Number	:	904-295-9253
Fax Number	:	888-659-8008

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	04/27/2023

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