Provider Demographics
NPI:1093436644
Name:BELLOWS, COLLEEN M (MOTR/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12191 MCKELVEY RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1239
Mailing Address - Country:US
Mailing Address - Phone:314-630-9170
Mailing Address - Fax:
Practice Address - Street 1:1118 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-3624
Practice Address - Country:US
Practice Address - Phone:314-345-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022001104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist