Provider Demographics
NPI:1891936241
Name:COUGHLIN, YOLANDA VON (OT)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:VON
Last Name:COUGHLIN
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 1:727 CROSSROADS CT
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9415
Mailing Address - Country:US
Mailing Address - Phone:937-890-9235
Mailing Address - Fax:937-890-9239
Practice Address - Street 1:727 CROSSROADS CT
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9415
Practice Address - Country:US
Practice Address - Phone:937-890-9235
Practice Address - Fax:937-890-9239
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT003207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist