MEDICARE: MARY CALLAHAN 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	235Z00000X	Speech-Language Pathologist	007651-1	NY

General Provider Information

NPI Number	:	1467742429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CALLAHAN KOEHLER

Provider Business Mailing Address
First Line	:	690 SAINT PAUL ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14605-1709
Country	:	US
Telephone Number	:	585-615-3603
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 HUMBOLDT ST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1221
Country	:	US
Telephone Number	:	585-615-3603
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	04/12/2011

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Directions to “ MARY CALLAHAN KOEHLER ” Practice Location

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