Healthcare Provider Details

I. General information

NPI: 1639294382
Provider Name (Legal Business Name): MRS. SARAH WHITESCARVER KOEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5110 PARK RD SUITE 1-C
CHARLOTTE NC
28209-3699
US

IV. Provider business mailing address

PO BOX 1494
BELMONT NC
28012-1494
US

V. Phone/Fax

Practice location:
  • Phone: 704-405-0155
  • Fax:
Mailing address:
  • Phone: 704-829-6074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number708
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: