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NPI Code Detail

MEDICARE: MS. ANDREA RAE OHLER MSW, CSW

MEDICARE: MS. ANDREA RAE OHLER MSW, CSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker252386KY

General Provider Information

NPI Number : 1063734747
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANDREA RAE OHLER MSW, CSW
Provider Business Mailing Address
First Line : 5159 HIGHWAY 80
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-8755
Country : US
Telephone Number : 616-312-2594
Fax Number :
Provider Business Practice Location Address
First Line : 5159 HIGHWAY 80
Second Line :
City : MANCHESTER
State : KY
Zip : 40962-8755
Country : US
Telephone Number : 616-312-2594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2010
Last Update Date : 12/12/2016

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