Provider Demographics
NPI:1326349184
Name:MACKRELL, COLLEEN RHEA (COTA)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:RHEA
Last Name:MACKRELL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 EAST MAIN STREET
Mailing Address - Street 2:SUITE 132
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711
Mailing Address - Country:US
Mailing Address - Phone:302-709-0440
Mailing Address - Fax:302-709-0443
Practice Address - Street 1:280 EAST MAIN STREET
Practice Address - Street 2:SUITE 132
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:302-709-0440
Practice Address - Fax:302-709-0443
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEU20001190224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant