Provider Demographics
NPI:1518455062
Name:COLGAN, JAMIE CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:CHRISTINE
Last Name:COLGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:CHRISTINE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:151 N ELLSWORTH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2849
Mailing Address - Country:US
Mailing Address - Phone:408-840-1110
Mailing Address - Fax:
Practice Address - Street 1:1501 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4506
Practice Address - Country:US
Practice Address - Phone:650-696-5447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13635225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist