Individual
JENNIFER COLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTRL
Contact information
Practice address
100 NORTHBROOKE TRCE, WOODSTOCK, GA 30188-2192
(678) 206-6838
Mailing address
100 NORTHBROOKE TRCE, WOODSTOCK, GA 30188-2192
(678) 206-6838
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003663
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
695050454A
—
GA
Enumeration date
12/14/2006
Last updated
02/22/2013
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