Healthcare Provider Details

I. General information

NPI: 1700286192
Provider Name (Legal Business Name): JILL KAHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE SUITE 107
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

2700 W 9TH AVE SUITE 107
OSHKOSH WI
54904-7247
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-1123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: