Doctor Name: | MRS. AUDREY JEAN KOLB |
NPI Number: | 1598034092 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.M.T. |
License Number: | 16306 |
Business Practice Address: | 790 E Powell Blvd Gresham, OR - 970307616 |
Business Phone Number: | 5039700147 |
Business Fax Number: | 5036180148 |
Mailing Address: | 3737 Ne 74th Ave, PORTLAND |
State: | OR |
Postal Code: | 972135722 |
Phone Number: | 9712124702 |
Fax Number: | |
NPI Enumeration Date: | 12/29/2011 |
NPI Last Update Date: | 07/31/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 16306 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |