Provider Demographics
NPI:1528569688
Name:COUGHLIN, COLLEEN (OTRL, CHT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:OTRL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E EISENHOWER PKWY SPC 5744
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-3364
Mailing Address - Country:US
Mailing Address - Phone:734-763-6464
Mailing Address - Fax:734-763-3715
Practice Address - Street 1:325 E EISENHOWER PKWY SPC 5744
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3364
Practice Address - Country:US
Practice Address - Phone:734-763-6464
Practice Address - Fax:734-763-3715
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008278225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand