Provider Demographics
NPI:1902398852
Name:COLBERT, KERRI J (OTL,CHT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:J
Last Name:COLBERT
Suffix:
Gender:F
Credentials:OTL,CHT
Other - Prefix:
Other - First Name:KERRI
Other - Middle Name:J
Other - Last Name:KIELY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OCCUPATIONAL THERAPI
Mailing Address - Street 1:650 TABOR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-2843
Mailing Address - Country:US
Mailing Address - Phone:831-234-5904
Mailing Address - Fax:831-480-1321
Practice Address - Street 1:1715 42ND AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3535
Practice Address - Country:US
Practice Address - Phone:831-234-5904
Practice Address - Fax:831-480-1321
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT5535225XH1200X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand