Provider Demographics
NPI:1467561068
Name:KOEHN, SHIELA JANE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:SHIELA
Middle Name:JANE
Last Name:KOEHN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 DERBYSHIRE PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-3973
Mailing Address - Country:US
Mailing Address - Phone:919-878-3899
Mailing Address - Fax:
Practice Address - Street 1:300 VEAZEY RD
Practice Address - Street 2:
Practice Address - City:BUTNER
Practice Address - State:NC
Practice Address - Zip Code:27509-0001
Practice Address - Country:US
Practice Address - Phone:919-764-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant