Provider Demographics
NPI:1013324060
Name:KOHLBRECHER, CRAIG JOSEPH (OTR/L, EMT)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:KOHLBRECHER
Suffix:
Gender:M
Credentials:OTR/L, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 J ROCK RD
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-2924
Mailing Address - Country:US
Mailing Address - Phone:618-806-9621
Mailing Address - Fax:618-224-9621
Practice Address - Street 1:1807 J ROCK RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-2924
Practice Address - Country:US
Practice Address - Phone:618-806-9621
Practice Address - Fax:618-224-9621
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.004002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist