Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 5642 | MN |
NPI | 1003987363 |
---|---|
Provider Name | Linda Koehler |
First Address | Wyoming, MN 55092-8013 |
Second Address | Wyoming, MN 55092-8013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 21/05/2008 |