Individual
COLLEEN MICHELLE LISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1911 S 17TH ST STE 100, WILMINGTON, NC 28401-6663
(910) 313-2111
(910) 313-2111
Mailing address
1911 S 17TH ST STE 100, WILMINGTON, NC 28401-6663
(910) 313-2111
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
10987
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10987
NC BOT LICENSE
NC
Enumeration date
07/10/2017
Last updated
07/10/2017
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