Provider Demographics
NPI:1205689056
Name:COLANTUONI, MIA (OTR/L)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:COLANTUONI
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 1:71 OLD PINE HILL RD N
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:93 WATER VILLAGE RD
Practice Address - Street 2:
Practice Address - City:OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03864-7208
Practice Address - Country:US
Practice Address - Phone:603-539-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3643225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist