Provider Demographics
NPI:1063949774
Name:KOLEY, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KOLEY
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 1:15-2662 PAHOA VILLAGE RD # 306-8529
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-7730
Mailing Address - Country:US
Mailing Address - Phone:508-783-0443
Mailing Address - Fax:
Practice Address - Street 1:13-104 NALU PL
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-7730
Practice Address - Country:US
Practice Address - Phone:508-783-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILMT-14039225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist