MEDICARE: JAMI KOHLMANN LMT

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	225700000X	Massage Therapist	227002618	IL

General Provider Information

NPI Number	:	1679166227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMI KOHLMANN LMT

Provider Business Mailing Address
First Line	:	2315 OSAGE DR
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61821-6346
Country	:	US
Telephone Number	:	217-721-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	3115 VILLAGE OFFICE PL
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61822-7673
Country	:	US
Telephone Number	:	217-531-4101
Fax Number	:

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

Provider Enumeration Date	:	02/15/2021
Last Update Date	:	02/15/2021

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