Provider Demographics
NPI:1942090030
Name:KOLB, MARIAH (RD)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:774 W 11TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5386
Mailing Address - Country:US
Mailing Address - Phone:808-341-0841
Mailing Address - Fax:
Practice Address - Street 1:774 W 11TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5386
Practice Address - Country:US
Practice Address - Phone:808-341-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10251209133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered