Provider Demographics
NPI:1124187182
Name:LAWRENCE, COLLEEN MARY-GLYNISS (OT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARY-GLYNISS
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-5241
Mailing Address - Country:US
Mailing Address - Phone:845-458-8661
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE # A-560
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-2300
Practice Address - Fax:212-562-3486
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist