Provider Demographics
NPI:1790957728
Name:COLVIN, BRIAN (OT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:COLVIN
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-0246
Mailing Address - Country:US
Mailing Address - Phone:216-227-7700
Mailing Address - Fax:
Practice Address - Street 1:16600 SPRAGUE ST.
Practice Address - Street 2:365
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:216-227-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT4906208100000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation