Provider Demographics
NPI:1053407171
Name:COLLINS, JOAN MARIE (OTR CHT)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:OTR CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 EAST BUSH LAKE RD.
Mailing Address - Street 2:#320
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55439
Mailing Address - Country:US
Mailing Address - Phone:952-831-5773
Mailing Address - Fax:952-831-7224
Practice Address - Street 1:7373 FRANCE AVENUE SOUTH
Practice Address - Street 2:#509
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-830-0069
Practice Address - Fax:612-925-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100327225X00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
411657919OtherUHC
791001OtherPREFERRED ONE
411657919OtherSELECT CARE
6400669OtherMEDICA PRIMARY
103164OtherUCARE
0592790001OtherADMINASTAR FED DMERC
140065700OtherMA SUPPLIES
2G11600OtherBLUE CROSS BLUE SHIE
363345400OtherMINNESOTA MEDICAL AS
HP31392OtherHEALTH PARTNERS
2G11600OtherMCHA
411657919OtherPATIENT CHOICE
6433664OtherMEDICA
103164OtherUCARE FOR SENIORS
MN363345400Medicaid
670000004OtherMINNESOTA MEDICARE
103164OtherUCARE
411657919OtherUHC