Healthcare Provider Details

I. General information

NPI: 1568977304
Provider Name (Legal Business Name): MADELINE KOLLER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROUTE 209 STE 103
GILBERT PA
18331-7751
US

IV. Provider business mailing address

650 FOREST DR
PALMERTON PA
18071-5220
US

V. Phone/Fax

Practice location:
  • Phone: 610-951-4330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: