Provider Demographics
NPI:1629167416
Name:CHINYERERE, COLLETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:COLLETTE
Middle Name:
Last Name:CHINYERERE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:COLLETTE
Other - Middle Name:
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1500 E 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-2601
Mailing Address - Country:US
Mailing Address - Phone:720-972-4790
Mailing Address - Fax:
Practice Address - Street 1:1500 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2601
Practice Address - Country:US
Practice Address - Phone:720-972-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003375A225XP0200X
FLOT12867225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100133720MMedicaid
IN1050696OtherNAT'L CERTIFICATION IN OT
FLOT12867OtherFL LISCENSURE
FLY905LOtherBCBS FL
FL892492900Medicaid