Provider Demographics
NPI:1568845840
Name:COX, COLLEEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:COX
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1732
Mailing Address - Country:US
Mailing Address - Phone:530-304-5360
Mailing Address - Fax:
Practice Address - Street 1:585 NUT TREE CT
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3353
Practice Address - Country:US
Practice Address - Phone:707-449-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA 2595314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility