Healthcare Provider Details

I. General information

NPI: 1396890703
Provider Name (Legal Business Name): LEE ANN PALOMBIT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEE ANN COLGLAZIER OTR

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0137
US

IV. Provider business mailing address

3701 BELLEMEADE AVE
EVANSVILLE IN
47714-0137
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-1411
  • Fax: 812-437-2636
Mailing address:
  • Phone: 812-479-1411
  • Fax: 812-437-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31000177A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number31000177A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31000177A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number31000177A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number31000177A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number31000177A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number31000177A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: