Provider Demographics
NPI:1700844503
Name:KOLMAN, BRUCE AVROM (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:AVROM
Last Name:KOLMAN
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4557
Mailing Address - Country:US
Mailing Address - Phone:707-546-1922
Mailing Address - Fax:707-569-8620
Practice Address - Street 1:131B STONY CIR
Practice Address - Street 2:SUITE 2000
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-9507
Practice Address - Country:US
Practice Address - Phone:707-546-1922
Practice Address - Fax:707-569-8620
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4553174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist