Provider Demographics
NPI:1942407176
Name:COLLINS, RITA FAYE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:FAYE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5020
Mailing Address - Country:US
Mailing Address - Phone:859-271-6441
Mailing Address - Fax:
Practice Address - Street 1:411 BERTHA WALLACE DR
Practice Address - Street 2:IRVINE HEALTH & REHAB. CENTER
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-9418
Practice Address - Country:US
Practice Address - Phone:606-723-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY185339Medicaid