Provider Demographics
NPI:1265766497
Name:KOHLER, KRISTINA MICHELE
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MICHELE
Last Name:KOHLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KRISTINA
Other - Middle Name:MICHELE
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2404 COPPER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5614
Mailing Address - Country:US
Mailing Address - Phone:618-288-1497
Mailing Address - Fax:
Practice Address - Street 1:2404 COPPER CREEK RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5614
Practice Address - Country:US
Practice Address - Phone:618-288-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist