Provider Demographics
NPI:1003828005
Name:KOLLMANN, ALISA M (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:M
Last Name:KOLLMANN
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:MISS
Other - First Name:ALISA
Other - Middle Name:M
Other - Last Name:HOLZHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT,OTR/L
Mailing Address - Street 1:420 THOMSON CIR
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5656
Mailing Address - Country:US
Mailing Address - Phone:864-366-5011
Mailing Address - Fax:
Practice Address - Street 1:104 W PINCKNEY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-2124
Practice Address - Country:US
Practice Address - Phone:864-366-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4132225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist