Provider Demographics
NPI:1578840690
Name:KOHLBRENNER, HEATHER STAR (B S ,MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:STAR
Last Name:KOHLBRENNER
Suffix:
Gender:F
Credentials:B S ,MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 CHESTER PIKE APT 1
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19074-1452
Mailing Address - Country:US
Mailing Address - Phone:610-505-8098
Mailing Address - Fax:
Practice Address - Street 1:525 CHESTER PIKE APT 1
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:PA
Practice Address - Zip Code:19074-1452
Practice Address - Country:US
Practice Address - Phone:610-505-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist