Provider Demographics
NPI:1831856772
Name:KOLB, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BLACK POINT RD APT 2
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-2938
Mailing Address - Country:US
Mailing Address - Phone:860-575-9636
Mailing Address - Fax:
Practice Address - Street 1:127 BLACK POINT RD APT 2
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-2938
Practice Address - Country:US
Practice Address - Phone:860-575-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program