Provider Demographics
NPI:1619096682
Name:KOHN, CHALISA A (BA, MT)
Entity Type:Individual
Prefix:MS
First Name:CHALISA
Middle Name:A
Last Name:KOHN
Suffix:
Gender:F
Credentials:BA, MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5399 E FREMONT RD
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:MI
Mailing Address - Zip Code:48883-9313
Mailing Address - Country:US
Mailing Address - Phone:989-621-7050
Mailing Address - Fax:
Practice Address - Street 1:5399 E FREMONT RD
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-9313
Practice Address - Country:US
Practice Address - Phone:989-621-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist