MEDICARE: CHERYL LYNNE KOEHLER

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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1184823387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNNE KOEHLER

Provider Business Mailing Address
First Line	:	30649 SPRINGLAND ST
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4674
Country	:	US
Telephone Number	:	248-819-7093
Fax Number	:

Provider Business Practice Location Address
First Line	:	30649 SPRINGLAND ST
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4674
Country	:	US
Telephone Number	:	248-819-7093
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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