Provider Demographics
NPI:1821276189
Name:KOLB, AMY THERESE (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:THERESE
Last Name:KOLB
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 S US HIGHWAY 131
Mailing Address - Street 2:PO BOX 501
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8336
Mailing Address - Country:US
Mailing Address - Phone:231-439-3750
Mailing Address - Fax:231-439-5918
Practice Address - Street 1:1691 S US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8336
Practice Address - Country:US
Practice Address - Phone:231-439-3750
Practice Address - Fax:231-439-5918
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201003002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist