MEDICARE: ANNA KOLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	LMT-14039	HI

General Provider Information

NPI Number	:	1063949774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA KOLEY

Provider Business Mailing Address
First Line	:	15-2662 PAHOA VILLAGE RD # 306-8529
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-7730
Country	:	US
Telephone Number	:	508-783-0443
Fax Number	:

Provider Business Practice Location Address
First Line	:	13-104 NALU PL
Second Line	:
City	:	PAHOA
State	:	HI
Zip	:	96778-7730
Country	:	US
Telephone Number	:	508-783-0443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	05/12/2017

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Directions to “ ANNA KOLEY ” Practice Location

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