Provider Demographics
NPI:1255868782
Name:COLLIER, KORY M
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:M
Last Name:COLLIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19405-1113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2751 DEKALB PIKE,
Practice Address - Street 2:
Practice Address - City:EAST NORRION
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-278-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014823225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty