Individual
LAURA LISE KOLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 3RD AVE S, ESCANABA, MI 49829-1237
(906) 786-5810
Mailing address
2683 W FAIR AVE, MARQUETTE, MI 49855-2247
(906) 869-3375
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201006352
MI
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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