Provider Demographics
NPI:1497287684
Name:KOESTER, CARLY (CPO)
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:
Last Name:KOESTER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MCHENRY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4352
Mailing Address - Country:US
Mailing Address - Phone:209-529-7221
Mailing Address - Fax:
Practice Address - Street 1:1707 MCHENRY AVE STE B
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4352
Practice Address - Country:US
Practice Address - Phone:209-529-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist