Provider Demographics
NPI:1760951420
Name:KOEHLE, MICHAEL JOSEPH (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:KOEHLE
Suffix:
Gender:M
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 1:1818 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3050
Mailing Address - Country:US
Mailing Address - Phone:143-815-2418
Mailing Address - Fax:
Practice Address - Street 1:437 GIVLER DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1635
Practice Address - Country:US
Practice Address - Phone:814-793-3728
Practice Address - Fax:814-793-3654
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08053225X00000X
PAOC013916225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOC013916OtherPENNSYLVANIA BOARD OF OCCUPATIONAL THERAPY