MEDICARE: CHARLIZE COLON 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	46TR01228600	NJ

General Provider Information

NPI Number	:	1497553622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLIZE COLON OTR/L

Provider Business Mailing Address
First Line	:	1455 BROAD ST STE 250
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-3066
Country	:	US
Telephone Number	:	877-532-7837
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 TICES LN
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2015
Country	:	US
Telephone Number	:	877-532-7837
Fax Number	:

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

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	01/19/2026

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