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Organization
COTA
Active
Organization
COTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KAITLIN MARIE BOMBA (COTA)
(219) 313-2555
Entity
Organization
Contact information
Practice address
2609 CALUMET AVE, DYER, IN 46311-1963
(219) 313-2555
Mailing address
2609 CALUMET AVE, DYER, IN 46311-1963
(219) 313-2555
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
—
CO
Other
Enumeration date
05/20/2013
Last updated
05/20/2013
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