Provider Demographics
NPI:1871800599
Name:COLL, DEREK (OTR/L)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:COLL
Suffix:
Gender:M
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 1:6934 SW 114TH PL APT H
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1876
Mailing Address - Country:US
Mailing Address - Phone:786-412-2538
Mailing Address - Fax:
Practice Address - Street 1:6934 SW 114TH PL
Practice Address - Street 2:UNIT H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1812
Practice Address - Country:US
Practice Address - Phone:786-412-2538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12161225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist