Provider Demographics
NPI:1700412475
Name:KIRKWOOD, COLETTE S (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:S
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24900 SE STARK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3381
Mailing Address - Country:US
Mailing Address - Phone:503-674-1123
Mailing Address - Fax:
Practice Address - Street 1:24900 SE STARK ST STE 106
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3381
Practice Address - Country:US
Practice Address - Phone:503-674-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand