Basic Information
| Provider Information | |||||||||
| NPI: | 1306030978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLLEY | ||||||||
| FirstName: | MIRANDA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MSOTR/L CLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 ELI PL | ||||||||
| Address2: | HAMILTON POINT HEALTH AND REHAB | ||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476307436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128535300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3800 ELI PL | ||||||||
| Address2: | HAMILTON POINT HEALTH AND REHAB | ||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476307436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128535300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 10/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | R3772 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 31004473A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.