Basic Information
| Provider Information | |||||||||
| NPI: | 1215232111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLEY | ||||||||
| FirstName: | ANNA | ||||||||
| MiddleName: | PEARSON | ||||||||
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| Credential: | MSOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1610 S WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | PAULS VALLEY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730756917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052074455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13609 CALIFORNIA ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681545260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004565857 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2011 | ||||||||
| LastUpdateDate: | 01/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1695 | OK | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.