Provider Demographics
NPI:1235728825
Name:COLLISHAW, CYNTHIA A (COTA/L)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:COLLISHAW
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 1:14 PEARL CT
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4802
Mailing Address - Country:US
Mailing Address - Phone:603-718-1977
Mailing Address - Fax:
Practice Address - Street 1:139 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-966-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0067224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant