Provider Demographics
NPI:1407410046
Name:KOHLWEY, TAYLOR (OTR/L)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:KOHLWEY
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 1:1175 SE OLSON DR APT 207
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8494
Mailing Address - Country:US
Mailing Address - Phone:402-641-6773
Mailing Address - Fax:
Practice Address - Street 1:1501 OFFICE PARK RD
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2497
Practice Address - Country:US
Practice Address - Phone:515-223-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist