Provider Demographics
NPI:1447017660
Name:BADER, COLLEEN (OTR/L)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:KALLOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4201 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33712-4051
Mailing Address - Country:US
Mailing Address - Phone:727-867-1104
Mailing Address - Fax:
Practice Address - Street 1:4201 31ST ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-4051
Practice Address - Country:US
Practice Address - Phone:727-867-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist