Provider Demographics
NPI:1003416835
Name:HERMANN, COLLEEN (COTA-L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:HERMANN
Suffix:
Gender:F
Credentials:COTA-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 NEW ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2741
Mailing Address - Country:US
Mailing Address - Phone:203-521-1552
Mailing Address - Fax:
Practice Address - Street 1:584 LONG HILL AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4810
Practice Address - Country:US
Practice Address - Phone:203-944-8252
Practice Address - Fax:203-944-8297
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001434224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant