Provider Demographics
NPI:1144576588
Name:COLLIER, MICHELLE ROGHELIA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ROGHELIA
Last Name:COLLIER
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 1:2067 KNIGHT ST
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-8773
Mailing Address - Country:US
Mailing Address - Phone:919-482-9623
Mailing Address - Fax:
Practice Address - Street 1:500 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2543
Practice Address - Country:US
Practice Address - Phone:919-692-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2899224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant