Provider Demographics
NPI:1104206937
Name:COLEGROVE, MARGARET JOAN (COTA/L)
Entity Type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:JOAN
Last Name:COLEGROVE
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 1:2510 W RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0853
Mailing Address - Country:US
Mailing Address - Phone:314-620-5394
Mailing Address - Fax:
Practice Address - Street 1:332 STABLE LN
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-5447
Practice Address - Country:US
Practice Address - Phone:636-332-4940
Practice Address - Fax:636-332-4941
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014032534224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant