Provider Demographics
NPI:1326319583
Name:RICE, COLLEEN M (COTA)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1846 BENSTON
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461
Mailing Address - Country:US
Mailing Address - Phone:231-894-6259
Mailing Address - Fax:
Practice Address - Street 1:4554 W. 48TH STREET
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412
Practice Address - Country:UM
Practice Address - Phone:231-924-9295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202006968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist