Provider Demographics
NPI:1164114005
Name:COLVILLE, COLLEEN ALEXANDRA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ALEXANDRA
Last Name:COLVILLE
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BROADWAY
Mailing Address - Street 2:APT 540
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215
Mailing Address - Country:US
Mailing Address - Phone:484-340-2146
Mailing Address - Fax:
Practice Address - Street 1:15430 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0989
Practice Address - Country:US
Practice Address - Phone:210-492-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist