Provider Demographics
NPI:1740528041
Name:KOHLER, VICKIE DAVIS (OT)
Entity type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:DAVIS
Last Name:KOHLER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 BROADWAY ST
Mailing Address - Street 2:3343 BETSY ROSS RD NW
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4771
Mailing Address - Country:US
Mailing Address - Phone:320-762-1762
Mailing Address - Fax:320-762-0796
Practice Address - Street 1:324 BROADWAY ST STE 206
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1482
Practice Address - Country:US
Practice Address - Phone:952-239-2918
Practice Address - Fax:952-239-2918
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1043182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist