Provider Demographics
NPI:1962281238
Name:COLQUHOUN, MARY KATE (OTR)
Entity type:Individual
Prefix:
First Name:MARY KATE
Middle Name:
Last Name:COLQUHOUN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:TUCKERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08087-0510
Mailing Address - Country:US
Mailing Address - Phone:609-746-9457
Mailing Address - Fax:
Practice Address - Street 1:100 MCKINLEY AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-6056
Practice Address - Country:US
Practice Address - Phone:609-333-3131
Practice Address - Fax:609-812-5112
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01096400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist