Provider Demographics
NPI:1376175034
Name:POHLMAN, KIRSTI EMALYN
Entity Type:Individual
Prefix:
First Name:KIRSTI
Middle Name:EMALYN
Last Name:POHLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21964 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:STE. GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670
Mailing Address - Country:US
Mailing Address - Phone:573-883-9366
Mailing Address - Fax:573-883-9377
Practice Address - Street 1:21964 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:STE. GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670
Practice Address - Country:US
Practice Address - Phone:573-883-9366
Practice Address - Fax:573-883-9377
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019032637225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist