Provider Demographics
NPI:1588738231
Name:WASEMANN, COLLEEN (OTD, MS, OTR)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:WASEMANN
Suffix:
Gender:F
Credentials:OTD, MS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 DIXON CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7387
Mailing Address - Country:US
Mailing Address - Phone:317-753-0930
Mailing Address - Fax:317-773-9583
Practice Address - Street 1:6330 E 75TH ST STE 206
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2700
Practice Address - Country:US
Practice Address - Phone:317-284-1166
Practice Address - Fax:317-284-1559
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003434A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200666760Medicaid