Provider Demographics
NPI:1366867921
Name:KOHLBRECHER, ROXANNE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:
Last Name:KOHLBRECHER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 J ROCK RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-2924
Mailing Address - Country:US
Mailing Address - Phone:618-224-9621
Mailing Address - Fax:
Practice Address - Street 1:485 S FRIENDSHIP DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1363
Practice Address - Country:US
Practice Address - Phone:618-327-3041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.001838225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist