Provider Demographics
NPI:1659512655
Name:KOLLMAR, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:KOLLMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOMESTEAD PARK DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4445
Mailing Address - Country:US
Mailing Address - Phone:919-446-4868
Mailing Address - Fax:919-551-7485
Practice Address - Street 1:1031 PEMBERTON HILL RD STE 203
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4278
Practice Address - Country:US
Practice Address - Phone:919-446-4868
Practice Address - Fax:919-551-7485
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6214225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist