Provider Demographics
NPI:1326833088
Name:KOLDEN, GREGORY JAMES (COTA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:KOLDEN
Suffix:
Gender:
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 TALLYHO LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2121
Mailing Address - Country:US
Mailing Address - Phone:608-220-5382
Mailing Address - Fax:
Practice Address - Street 1:500 1ST ST SE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6346
Practice Address - Country:US
Practice Address - Phone:507-332-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202834224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant