Provider Demographics
NPI:1760781884
Name:O'CONNOR, COLEEN M (CMT)
Entity Type:Individual
Prefix:MRS
First Name:COLEEN
Middle Name:M
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BALCHEN WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-4702
Mailing Address - Country:US
Mailing Address - Phone:201-400-0219
Mailing Address - Fax:
Practice Address - Street 1:6-16 E BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-4664
Practice Address - Country:US
Practice Address - Phone:201-400-0219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00224700225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist