Individual
AIDA I COLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD/OTR/L,MS,BS
Contact information
Practice address
115 MAIN ST, AXIOM PT & OT PLUS, PLLC-SUITE 202, TUCKAHOE, NY 10707-2948
(914) 961-1010
(914) 961-1011
Mailing address
115 MAIN ST, AXIOM PT & OT PLUS, PLLC-SUITE 202, TUCKAHOE, NY 10707-2948
(914) 961-1010
(914) 961-1011
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
015130
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PEMDING
EMPIRE BLUE CROSS
NY
01
—
PENDING
MVP HEALTHCARE
NY
05
—
PENDING
—
NY
Enumeration date
11/24/2008
Last updated
09/21/2016
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