Provider Demographics
NPI:1215681150
Name:COLLAZO, TRISHA (COTA/L)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:
Other - Last Name:BERRYMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:1060 KILARNEY ROAD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-916-0484
Mailing Address - Fax:
Practice Address - Street 1:700 DICKINSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3540
Practice Address - Country:US
Practice Address - Phone:219-983-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002701A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant