Provider Demographics
NPI:1700903150
Name:COLLINS, TOWANDA (OTR L)
Entity Type:Individual
Prefix:MISS
First Name:TOWANDA
Middle Name:
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 1:12421 S RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60827-5817
Mailing Address - Country:US
Mailing Address - Phone:708-489-2639
Mailing Address - Fax:
Practice Address - Street 1:12421 S RACINE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET PARK
Practice Address - State:IL
Practice Address - Zip Code:60827-5817
Practice Address - Country:US
Practice Address - Phone:708-489-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist