Provider Demographics
NPI:1356321301
Name:ROCHE, COLLEEN O'CONNELL (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:O'CONNELL
Last Name:ROCHE
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 1:3174 ELLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2000
Mailing Address - Country:US
Mailing Address - Phone:703-280-9593
Mailing Address - Fax:
Practice Address - Street 1:3174 ELLENWOOD DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2000
Practice Address - Country:US
Practice Address - Phone:703-280-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist