Individual
TINA KOLLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2700 1ST AVE S, FORT DODGE, IA 50501-4306
(515) 955-6922
(515) 955-2463
Mailing address
2926 BRUSHY CREEK RD, LEHIGH, IA 50557-7513
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01372
IA
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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