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NPI Code Detail

MEDICARE: MRS. MARISA KOHNEN OTR

MEDICARE: MRS. MARISA KOHNEN OTR
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
1225X00000XOccupational Therapist31003944AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000387925OTHERINANTHEM PROVIDER PIN

General Provider Information

NPI Number : 1861579781
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISA KOHNEN OTR
Provider Business Mailing Address
First Line : 3252 ATLANTA BLVD
Second Line :
City : PORTAGE
State : IN
Zip : 46368-5150
Country : US
Telephone Number : 219-762-9373
Fax Number : 219-983-9681
Provider Business Practice Location Address
First Line : 1120 S CALUMET RD STE 3
Second Line :
City : CHESTERTON
State : IN
Zip : 46304-3286
Country : US
Telephone Number : 219-983-9675
Fax Number : 219-983-9681
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/09/2007

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