Provider Demographics
NPI:1215573746
Name:WRIGHT, COLLEEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16010 CARNIVAL AVE
Mailing Address - Street 2:
Mailing Address - City:UPPERCO
Mailing Address - State:MD
Mailing Address - Zip Code:21155-9509
Mailing Address - Country:US
Mailing Address - Phone:443-929-4804
Mailing Address - Fax:
Practice Address - Street 1:1410 FOREST DR STE 29
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1446
Practice Address - Country:US
Practice Address - Phone:410-280-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08849225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics