Provider Demographics
NPI:1033385398
Name:GOLLOBIT, MICHELLE A (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:GOLLOBIT
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 ORIOLE AVE
Mailing Address - Street 2:PO BOX 173
Mailing Address - City:COON RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:50058-7518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1138 ORIOLE AVE
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:50058-7518
Practice Address - Country:US
Practice Address - Phone:575-491-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist