Provider Demographics
NPI:1700230943
Name:KOLB, JAMIE (AT, ATC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 SNOW VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-0777
Mailing Address - Country:US
Mailing Address - Phone:513-532-6814
Mailing Address - Fax:
Practice Address - Street 1:5156 SNOW VALLEY LN
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-0777
Practice Address - Country:US
Practice Address - Phone:513-532-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0048092255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer