Provider Demographics
NPI:1891704979
Name:COLINS, SANDRA A (OTR/L)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:COLINS
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 1:2462 SPRUCE RD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1052
Mailing Address - Country:US
Mailing Address - Phone:708-752-6272
Mailing Address - Fax:708-799-1264
Practice Address - Street 1:2462 SPRUCE RD
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1052
Practice Address - Country:US
Practice Address - Phone:708-752-6272
Practice Address - Fax:708-799-1264
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist