Provider Demographics
NPI:1821341033
Name:KOSTER, MARY BETH (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:KOSTER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:ZIMMERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-0365
Mailing Address - Country:US
Mailing Address - Phone:907-224-2800
Mailing Address - Fax:
Practice Address - Street 1:417 FIRST AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-0365
Practice Address - Country:US
Practice Address - Phone:907-224-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1009225X00000X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation