Provider Demographics
NPI:1588875520
Name:COULOMBE, KHALAN RUTH (OTR)
Entity type:Individual
Prefix:MRS
First Name:KHALAN
Middle Name:RUTH
Last Name:COULOMBE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62A DEVITT RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-1004
Mailing Address - Country:US
Mailing Address - Phone:518-233-1207
Mailing Address - Fax:
Practice Address - Street 1:421 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2217
Practice Address - Country:US
Practice Address - Phone:518-238-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012263-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist