Provider Demographics
NPI:1477814366
Name:COLL, LINDA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 RUNNING BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9313
Mailing Address - Country:US
Mailing Address - Phone:646-374-9186
Mailing Address - Fax:407-201-6821
Practice Address - Street 1:2855 RUNNING BROOK CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9313
Practice Address - Country:US
Practice Address - Phone:646-374-9186
Practice Address - Fax:407-201-6821
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1149000174400000X, 222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No174400000XOther Service ProvidersSpecialist