Provider Demographics
NPI:1245437334
Name:COLVIN, ANNE P (OT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:P
Last Name:COLVIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 FARMERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3007
Mailing Address - Country:US
Mailing Address - Phone:318-255-9601
Mailing Address - Fax:318-255-7971
Practice Address - Street 1:1923 FARMERVILLE HWY
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3007
Practice Address - Country:US
Practice Address - Phone:318-255-9601
Practice Address - Fax:318-255-7971
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10943225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG5096OtherBCBS
LA1169234Medicaid
LA19-6636Medicare ID - Type UnspecifiedMEDICARE