Provider Demographics
NPI:1699388520
Name:MICHELLE COLQUHOUN OT, LLC
Entity Type:Organization
Organization Name:MICHELLE COLQUHOUN OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLQUHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:541-408-8197
Mailing Address - Street 1:60457 ZUNI RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-7943
Mailing Address - Country:US
Mailing Address - Phone:541-408-8197
Mailing Address - Fax:
Practice Address - Street 1:131 NW HAWTHORNE AVE STE 202
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2958
Practice Address - Country:US
Practice Address - Phone:541-408-8197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty