Provider Demographics
NPI:1700232782
Name:MCFAWN, COLLEEN GRIFFIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:GRIFFIN
Last Name:MCFAWN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7086 8TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428
Mailing Address - Country:US
Mailing Address - Phone:616-667-9551
Mailing Address - Fax:
Practice Address - Street 1:1310 E BELTLINE AVE SE STE 230
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4304
Practice Address - Country:US
Practice Address - Phone:616-288-3732
Practice Address - Fax:616-288-9857
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201009477225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics