Provider Demographics
NPI:1215335856
Name:COLAVINCENZO, ANNE
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:COLAVINCENZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-4000
Mailing Address - Country:US
Mailing Address - Phone:937-609-0616
Mailing Address - Fax:
Practice Address - Street 1:3317 GARLAND ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-4000
Practice Address - Country:US
Practice Address - Phone:937-609-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-14
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201008763225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics