Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 4132 | SC |
NPI | 1003828005 |
---|---|
Provider Name | Mrs. Alisa M Kollmann |
First Address | Abbeville, SC 29620-5656 |
Second Address | Abbeville, SC 29620-2124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 11/04/2014 |