Provider Demographics
NPI:1578512455
Name:DOLBY, KRISTIN ANNE (OTRL)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNE
Last Name:DOLBY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ANNE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 COBBLESTONE LANE
Mailing Address - Street 2:COURAGE BURNSVILLE
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306
Mailing Address - Country:US
Mailing Address - Phone:952-898-5700
Mailing Address - Fax:952-898-5757
Practice Address - Street 1:100 COBBLESTONE LANE
Practice Address - Street 2:COURAGE BURNSVILLE
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306
Practice Address - Country:US
Practice Address - Phone:952-898-5700
Practice Address - Fax:952-898-5757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN100118225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49Q12D0OtherBCBS MINNESOTA
6407018OtherMEDICA
HP24279OtherHEALTH PARTNERS