Provider Demographics
NPI:1194109546
Name:COLSON, JUSTINE A (OTR/L)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:A
Last Name:COLSON
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 1:12208 BRADBURY DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2013
Mailing Address - Country:US
Mailing Address - Phone:301-613-3090
Mailing Address - Fax:
Practice Address - Street 1:1371 HARVARD ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4903
Practice Address - Country:US
Practice Address - Phone:202-674-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13423225X00000X
MD08533225X00000X
DCOT010001082225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist