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NPI Code Detail

MEDICARE: MS. COLLEEN M MITCHELL OTA

MEDICARE: MS. COLLEEN M MITCHELL OTA
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
1224Z00000XOccupational Therapy Assistant001276-1NY

General Provider Information

NPI Number : 1336430529
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COLLEEN M MITCHELL OTA
Provider Business Mailing Address
First Line : 3374 FRANKLIN AVE
Second Line :
City : MILLBROOK
State : NY
Zip : 12545-5969
Country : US
Telephone Number : 845-677-6196
Fax Number :
Provider Business Practice Location Address
First Line : 3374 FRANKLIN AVENUE
Second Line :
City : MILLBROOK
State : NY
Zip : 12545-5969
Country : US
Telephone Number : 845-677-3251
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2011
Last Update Date : 04/22/2011

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