Provider Demographics
NPI:1518271550
Name:COLONNA, MARIA LOUISA (OT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LOUISA
Last Name:COLONNA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LYNDON PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4255
Mailing Address - Country:US
Mailing Address - Phone:631-659-3096
Mailing Address - Fax:
Practice Address - Street 1:4 LYNDON PL
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4255
Practice Address - Country:US
Practice Address - Phone:631-659-3096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011759225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics