MEDICARE: MRS. SARAH WHITESCARVER KOEHLER

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	237700000X	Hearing Instrument Specialist	708	NC

General Provider Information

NPI Number	:	1639294382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH WHITESCARVER KOEHLER

Provider Business Mailing Address
First Line	:	PO BOX 1494
Second Line	:
City	:	BELMONT
State	:	NC
Zip	:	28012-1494
Country	:	US
Telephone Number	:	704-829-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 PARK RD
Second Line	:	SUITE 1-C
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3699
Country	:	US
Telephone Number	:	704-405-0155
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/12/2008

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