Provider Demographics
NPI:1205477353
Name:COLLINS, JORDAN KATIBETH (OTR/L)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:KATIBETH
Last Name:COLLINS
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 1:2065 BALMORAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8841
Mailing Address - Country:US
Mailing Address - Phone:803-372-7297
Mailing Address - Fax:
Practice Address - Street 1:85C VINCENT DR
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4030
Practice Address - Country:US
Practice Address - Phone:843-425-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOT.5685225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics