Provider Demographics
NPI:1508941519
Name:COGHLAN, CATHY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:COGHLAN
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 1:204 W WARREN ST
Mailing Address - Street 2:PO BOX 220
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9617
Mailing Address - Country:US
Mailing Address - Phone:715-749-3890
Mailing Address - Fax:715-749-4081
Practice Address - Street 1:204 W WARREN ST
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9617
Practice Address - Country:US
Practice Address - Phone:715-749-3890
Practice Address - Fax:715-749-4081
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102261225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN083H8COOtherBCBS
MN64-01215OtherMEDICA
MNHP57053OtherHEALTHPARTNERS