Individual
MRS. AUDREY JEAN KOLB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T.
Contact information
Practice address
790 E POWELL BLVD, GRESHAM, OR 97030-7616
(503) 970-0147
(503) 618-0148
Mailing address
3737 NE 74TH AVE, PORTLAND, OR 97213-5722
(971) 212-4702
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
16306
OR
Other
Enumeration date
12/29/2011
Last updated
07/31/2013
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