Provider Demographics
NPI:1962051243
Name:DILLON, COLLEEN MARY (OTD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARY
Last Name:DILLON
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 W RUSSELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1238
Mailing Address - Country:US
Mailing Address - Phone:702-499-6638
Mailing Address - Fax:
Practice Address - Street 1:9121 W RUSSELL RD STE 115
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1238
Practice Address - Country:US
Practice Address - Phone:702-499-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2349225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics