Provider Demographics
NPI:1356856892
Name:COLLIER, JOSHUA THORP (OTR)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:THORP
Last Name:COLLIER
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N85W17948 ANN AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2684
Mailing Address - Country:US
Mailing Address - Phone:414-366-1109
Mailing Address - Fax:
Practice Address - Street 1:1850 BOWEN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2356
Practice Address - Country:US
Practice Address - Phone:920-233-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6180-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist