Provider Demographics
NPI:1164899928
Name:FITZGERALD, COLLEEN
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EKMAN ST
Mailing Address - Street 2:APT 3
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01607-1514
Mailing Address - Country:US
Mailing Address - Phone:978-870-3545
Mailing Address - Fax:
Practice Address - Street 1:6 EKMAN ST
Practice Address - Street 2:APT 3
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01607-1514
Practice Address - Country:US
Practice Address - Phone:978-870-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant