Healthcare Provider Details

I. General information

NPI: 1588406763
Provider Name (Legal Business Name): MARY KOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13143 151ST LN N
JUPITER FL
33478-3533
US

IV. Provider business mailing address

13143 151ST LN N
JUPITER FL
33478-3533
US

V. Phone/Fax

Practice location:
  • Phone: 561-312-8723
  • Fax:
Mailing address:
  • Phone: 561-312-8723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW26760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: