Healthcare Provider Details

I. General information

NPI: 1124711577
Provider Name (Legal Business Name): CHRISTOPHER KOHLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 WEST RD
MOUNTAIN HOME AR
72653-4544
US

IV. Provider business mailing address

209 MUSCOVY DR
MOUNTAIN HOME AR
72653-5431
US

V. Phone/Fax

Practice location:
  • Phone: 870-834-0336
  • Fax:
Mailing address:
  • Phone: 870-834-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR2319
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: