Provider Demographics
NPI:1558527994
Name:KOHLER, CONSTANCE R (OT)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:R
Last Name:KOHLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 WATERMILL CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1024
Mailing Address - Country:US
Mailing Address - Phone:703-307-4305
Mailing Address - Fax:
Practice Address - Street 1:10904 WATERMILL CT
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1024
Practice Address - Country:US
Practice Address - Phone:703-307-4305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002099225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist