Provider Demographics
NPI:1063732527
Name:NIELSEN, COLLEEN L (OTR/L)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:L
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:550 W FRONTAGE RD
Mailing Address - Street 2:SUITE 2415
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1202
Mailing Address - Country:US
Mailing Address - Phone:563-259-4094
Mailing Address - Fax:847-386-5191
Practice Address - Street 1:240 N BLUFF BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7146
Practice Address - Country:US
Practice Address - Phone:563-242-4422
Practice Address - Fax:563-243-8329
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00544225X00000X
IL056002724225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist