Provider Demographics
NPI:1841025772
Name:KOLMAN, KELLY (OTR/L)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KOLMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 IVY CREST WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4475
Mailing Address - Country:US
Mailing Address - Phone:678-205-7313
Mailing Address - Fax:
Practice Address - Street 1:477 PROMINENCE CT STE 100
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6377
Practice Address - Country:US
Practice Address - Phone:401-216-9564
Practice Address - Fax:678-951-8226
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009087225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics