Provider Demographics
NPI:1316149933
Name:SCHMITZ, COLLEEN G (OT)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:G
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:919-220-6971
Practice Address - Street 1:120 WILLIAM PENN PLZ
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2150
Practice Address - Country:US
Practice Address - Phone:919-220-5255
Practice Address - Fax:919-220-6971
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1075225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1075OtherNC LICENSE NUMBER
NC2511887Medicare PIN