Provider Demographics
NPI:1043769540
Name:GOLDEN, COLBY (OTR)
Entity Type:Individual
Prefix:MR
First Name:COLBY
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 LATOURETTE LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-0797
Mailing Address - Country:US
Mailing Address - Phone:870-935-7550
Mailing Address - Fax:
Practice Address - Street 1:1705 LATOURETTE LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-0797
Practice Address - Country:US
Practice Address - Phone:870-935-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1371225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist