Provider Demographics
NPI:1972004919
Name:O'CONNELL-FIX, COLLEEN TERESE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:TERESE
Last Name:O'CONNELL-FIX
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 1:28100 GRAND RIVER AVE STE 210-S
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5967
Mailing Address - Country:US
Mailing Address - Phone:248-471-8648
Mailing Address - Fax:248-471-8781
Practice Address - Street 1:28100 GRAND RIVER AVE STE 210-S
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5967
Practice Address - Country:US
Practice Address - Phone:248-471-8648
Practice Address - Fax:248-471-8781
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201000766225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist