Healthcare Provider Details

I. General information

NPI: 1124442785
Provider Name (Legal Business Name): ANGELA KOHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 COUNTY ROAD 13
KANSAS OH
44841-9617
US

IV. Provider business mailing address

5200 COUNTY ROAD 13
KANSAS OH
44841-9617
US

V. Phone/Fax

Practice location:
  • Phone: 419-986-6650
  • Fax: 419-986-6651
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberOH1550669
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: