Provider Demographics
NPI:1669987244
Name:IWANSKI, COLETTE
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:IWANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12480 ROSE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-4435
Mailing Address - Country:US
Mailing Address - Phone:727-542-7149
Mailing Address - Fax:
Practice Address - Street 1:12480 ROSE ST APT 4
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4435
Practice Address - Country:US
Practice Address - Phone:727-542-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT8142225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist