Provider Demographics
NPI:1326381633
Name:COLOME, MICHELSENT (PTA)
Entity type:Individual
Prefix:
First Name:MICHELSENT
Middle Name:
Last Name:COLOME
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW 57TH AVE
Mailing Address - Street 2:STE 125
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2018
Mailing Address - Country:US
Mailing Address - Phone:305-267-4414
Mailing Address - Fax:305-267-4846
Practice Address - Street 1:815 NW 57TH AVE
Practice Address - Street 2:STE 125
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2018
Practice Address - Country:US
Practice Address - Phone:305-267-4414
Practice Address - Fax:305-267-4846
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12440224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant