Provider Demographics
NPI:1184830259
Name:COLLINS, LINDA MAY (MS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MAY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1590 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-1242
Mailing Address - Country:US
Mailing Address - Phone:920-982-5440
Mailing Address - Fax:920-982-0444
Practice Address - Street 1:307 SMITH ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:WI
Practice Address - Zip Code:54961-1410
Practice Address - Country:US
Practice Address - Phone:920-982-5440
Practice Address - Fax:920-982-0444
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1667-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40697300Medicaid