Provider Demographics
NPI:1053803015
Name:COLON, AILEEN (OTR/L)
Entity type:Individual
Prefix:MISS
First Name:AILEEN
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 SW 114TH PL APT B
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4726
Mailing Address - Country:US
Mailing Address - Phone:305-793-9535
Mailing Address - Fax:
Practice Address - Street 1:6704 SW 114TH PL APT B
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4726
Practice Address - Country:US
Practice Address - Phone:305-793-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist