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Individual

LEESOLEE KOLOKOLLIE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5633 25TH STREET CIR E, BRADENTON, FL 34203-4910
(941) 580-2461
Mailing address
5633 25TH STREET CIR E, BRADENTON, FL 34203-4910

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA11368
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OTA 11368
FLORIDA
FL
Enumeration date
01/10/2012
Last updated
01/10/2012
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