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General NPI Number Information
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NPI Number | 1609658673
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Entity Type | Individual
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Provider Name | BROCK KOLANDER
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Gender | Male
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 913 NW GARDEN VALLEY BLVD
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City | ROSEBURG
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State | OR
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Zip | 97471-6523
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Country | US
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Telephone | 541-440-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 1492 NW CARL AVE
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City | ROSEBURG
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State | OR
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Zip | 97471-1903
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Country | US
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Telephone | 507-461-5110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 457961
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License Number State | OR
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