Provider Demographics
NPI:1427193192
Name:KOEHN, JEANMARIE (CRT,RCP)
Entity Type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:
Last Name:KOEHN
Suffix:
Gender:F
Credentials:CRT,RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 35TH AVE N
Mailing Address - Street 2:UNIT B
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1303
Mailing Address - Country:US
Mailing Address - Phone:919-235-2949
Mailing Address - Fax:888-803-0047
Practice Address - Street 1:606 35TH AVE N
Practice Address - Street 2:UNIT B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1303
Practice Address - Country:US
Practice Address - Phone:919-235-2949
Practice Address - Fax:888-803-0047
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-2946227800000X
SCTL5894227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211265Medicaid
NC1386YOtherBCBS INDIVIDUAL#
NC7492633Medicaid
NC016W0OtherBCBS GROUP#
NC1942300108OtherNPI GROUP