Provider Demographics
NPI:1134245012
Name:KOEHLER, SANDRA RUTH (MA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:RUTH
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:RUTH
Other - Last Name:BLUNBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:9909 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6361
Mailing Address - Country:US
Mailing Address - Phone:240-864-6200
Mailing Address - Fax:240-864-6209
Practice Address - Street 1:9909 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6361
Practice Address - Country:US
Practice Address - Phone:240-864-6200
Practice Address - Fax:240-864-6209
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05103235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist