MEDICARE: MISS TAMARA LOUISE KOEHLER MS CCC-SLP

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	7864	MN

General Provider Information

NPI Number	:	1588705719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TAMARA LOUISE KOEHLER MS CCC-SLP

Provider Business Mailing Address
First Line	:	1609 29TH ST SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-5655
Country	:	US
Telephone Number	:	507-289-6669
Fax Number	:

Provider Business Practice Location Address
First Line	:	2746 SUPERIOR DR NW
Second Line	:	SUITE 300
City	:	ROCHESTER
State	:	MN
Zip	:	55901-8343
Country	:	US
Telephone Number	:	507-288-0064
Fax Number	:	507-288-3993

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	07/08/2007

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