Provider Demographics
NPI:1023284577
Name:COLLINS, AGNES WHISNANT (COTA/L)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:WHISNANT
Last Name:COLLINS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-8800
Mailing Address - Country:US
Mailing Address - Phone:828-433-7651
Mailing Address - Fax:
Practice Address - Street 1:416 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2110
Practice Address - Country:US
Practice Address - Phone:704-864-0371
Practice Address - Fax:704-853-0983
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4680224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant