Provider Demographics
NPI:1144462789
Name:LISTER, COLETTE GERMAINE (OTR)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:GERMAINE
Last Name:LISTER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 RISA BENJAMIN WAY
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-8096
Mailing Address - Country:US
Mailing Address - Phone:814-592-2015
Mailing Address - Fax:
Practice Address - Street 1:5 RISA BENJAMIN WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-8096
Practice Address - Country:US
Practice Address - Phone:814-592-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00475500225X00000X
CA10642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist