Provider Demographics
NPI:1083674394
Name:COLLOP, TINA S (OTR/L)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:COLLOP
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19215 PENINSULA SHORES DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7579
Mailing Address - Country:US
Mailing Address - Phone:704-895-7343
Mailing Address - Fax:704-237-3463
Practice Address - Street 1:7915 HARBOR MASTER CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8782
Practice Address - Country:US
Practice Address - Phone:704-483-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist