Provider Demographics
NPI:1245633981
Name:MCMAHON, COLLEEN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:CHMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1510 CLARENDON BLVD.
Mailing Address - Street 2:#1203
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209
Mailing Address - Country:US
Mailing Address - Phone:516-993-8139
Mailing Address - Fax:
Practice Address - Street 1:100 ENGLAND ST.
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005
Practice Address - Country:US
Practice Address - Phone:804-368-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019172225X00000X
VA0119-007822225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist