Provider Demographics
NPI:1194538132
Name:MAGESTRO, COLLEEN MARY
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:MAGESTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:MARY
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:128 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1745
Mailing Address - Country:US
Mailing Address - Phone:267-575-0741
Mailing Address - Fax:
Practice Address - Street 1:128 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1745
Practice Address - Country:US
Practice Address - Phone:267-575-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC014540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist