Provider Demographics
NPI:1952691826
Name:ADAMS, COLLEEN GAYLE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:GAYLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 E SIDE DR
Mailing Address - Street 2:
Mailing Address - City:VERONA ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04416-3020
Mailing Address - Country:US
Mailing Address - Phone:207-735-3333
Mailing Address - Fax:
Practice Address - Street 1:31 BILLINGS RD
Practice Address - Street 2:
Practice Address - City:HERMON
Practice Address - State:ME
Practice Address - Zip Code:04401-0525
Practice Address - Country:US
Practice Address - Phone:207-848-4000
Practice Address - Fax:207-848-5226
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA1479224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant