Provider Demographics
NPI:1669881587
Name:BOHL, EMILY CAROLINE (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:CAROLINE
Last Name:BOHL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IL
Mailing Address - Zip Code:62341-1825
Mailing Address - Country:US
Mailing Address - Phone:319-795-7952
Mailing Address - Fax:
Practice Address - Street 1:20 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2062
Practice Address - Country:US
Practice Address - Phone:319-524-5772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074537224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant