MEDICARE: MRS. COLLEEN M KLOSTERMAN O.T.R.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	5201001755	MI

General Provider Information

NPI Number	:	1164663241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN M KLOSTERMAN O.T.R.

Provider Business Mailing Address
First Line	:	479 LENA HILL DR
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-4220
Country	:	US
Telephone Number	:	586-752-5419
Fax Number	:

Provider Business Practice Location Address
First Line	:	479 LENA HILL DR
Second Line	:
City	:	LEONARD
State	:	MI
Zip	:	48367-4220
Country	:	US
Telephone Number	:	586-752-5419
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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