Provider Demographics
NPI:1306030978
Name:KOLLEY, MIRANDA J (MSOTR/L CLT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:J
Last Name:KOLLEY
Suffix:
Gender:F
Credentials:MSOTR/L CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 ELI PL
Mailing Address - Street 2:HAMILTON POINT HEALTH AND REHAB
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-7436
Mailing Address - Country:US
Mailing Address - Phone:812-853-5300
Mailing Address - Fax:
Practice Address - Street 1:3800 ELI PL
Practice Address - Street 2:HAMILTON POINT HEALTH AND REHAB
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-7436
Practice Address - Country:US
Practice Address - Phone:812-853-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3772225X00000X
IN31004473A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist